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General NPI Number Information
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NPI Number | 1568491728
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Entity Type | Organization
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Legal Business Name | KIDNEY DISEASE & HYPERTENSION CENTERS, PA
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2712 CRISWELL AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-1143
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Country | US
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Telephone | 228-762-0713
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Fax | 228-762-0712
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Provider Business Mailing Address
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Address Line | 2712 CRISWELL AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-1143
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Country | US
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Telephone | 228-762-0713
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Fax | 228-762-0712
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL R BRUNT
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Credential | MD
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Telephone | 228-762-0713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 09811
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License Number State | MS
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