MEDICARE: S W 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	207RN0300X	Nephrology Physician	ME73225	FL

General Provider Information

NPI Number	:	1134273410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S W NEPHROLOGY SERVICES INC

Provider Business Mailing Address
First Line	:	22655 BAYSHORE RD
Second Line	:	STE 110
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2003
Country	:	US
Telephone Number	:	941-629-7092
Fax Number	:

Provider Business Practice Location Address
First Line	:	22655 BAYSHORE RD
Second Line	:	STE 110
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2003
Country	:	US
Telephone Number	:	941-629-7092
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRISHNAMURTY VELAMAKANNI
Credential	:	MD
Telephone Number	:	941-629-7092

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/25/2008

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