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General NPI Number Information
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NPI Number | 1366448458
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Entity Type | Organization
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Legal Business Name | NORTHLAKE NEPHROLOGY INC
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1970 N HWY 190
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City | COVINGTON
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State | LA
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Zip | 70433
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Country | US
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Telephone | 985-400-5988
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Fax | 985-256-5687
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Provider Business Mailing Address
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Address Line | PO BOX 3370
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City | COVINGTON
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State | LA
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Zip | 70434-3370
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Country | US
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Telephone | 985-867-8585
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Fax | 985-867-3644
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Authorized Official
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Title or Position | MD / OWNER
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Name | JOHN C SIMON
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Credential | MD
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Telephone | 985-867-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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