MEDICARE: NEPHROLOGY ASSOCIATES PC

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

General Provider Information

NPI Number	:	1215981147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPHROLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	PO BOX 3471
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68103-0471
Country	:	US
Telephone Number	:	605-335-1952
Fax Number	:	605-373-9971

Provider Business Practice Location Address
First Line	:	6709 S. MINNESOTA AVENUE
Second Line	:	SUITE 101
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2593
Country	:	US
Telephone Number	:	605-496-7002
Fax Number	:	877-543-8251

Authorized Official
Title or Position	:	PROVIDER
Name	:	OLEG P GEORGIEV
Credential	:	MD
Telephone Number	:	605-496-7002

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	06/29/2021

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