MEDICARE: INDEPENDENT NEPHROLOGY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1073567137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT NEPHROLOGY SERVICES, INC.

Provider Business Mailing Address
First Line	:	15705 KNOX HILL RD
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5691
Country	:	US
Telephone Number	:	704-896-6869
Fax Number	:	704-655-7244

Provider Business Practice Location Address
First Line	:	855 BETHESDA RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3026
Country	:	US
Telephone Number	:	704-896-6869
Fax Number	:	704-655-7244

Authorized Official
Title or Position	:	CEO
Name	:	RONALD F SAWYER
Credential	:
Telephone Number	:	704-896-6869

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/22/2020

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