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General NPI Number Information
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NPI Number | 1114794286
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Entity Type | Organization
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Legal Business Name | NEPHROLOGY AND HYPERTENSION ASSOCIATES
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 1205 W BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65203-2125
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Country | US
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Telephone | 573-499-0642
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Fax | 573-449-1787
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Provider Business Mailing Address
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Address Line | 1205 W BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65203-2125
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Country | US
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Telephone | 573-499-0642
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Fax | 573-449-1787
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | PAMELA DODGE
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Credential |
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Telephone | 573-499-0642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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