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General NPI Number Information
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NPI Number | 1609987825
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Entity Type | Organization
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Legal Business Name | GREENVILLE KIDNEY CENTER, PA
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 10 MEMORIAL MEDICAL DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4450
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Country | US
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Telephone | 864-220-1200
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Fax | 864-220-1888
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Provider Business Mailing Address
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Address Line | 10 MEMORIAL MEDICAL DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4450
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Country | US
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Telephone | 864-220-1200
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Fax | 864-220-1888
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM C KENDRICK JR.
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Credential | M.D.
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Telephone | 864-220-1200
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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 | 9047
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License Number State | SC
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