=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306363635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEPHROMED ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2017
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4002 S LOOP 256 STE F
-----------------------------------------------------
City | PALESTINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75801-8493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-723-8210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4002 S LOOP 256 F
-----------------------------------------------------
City | PALESTINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75801-8493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. MODINAT ADEWALE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-729-1071
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------