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NPI Code Detail

MEDICARE: LANDMARK NEPHROLOGY & HYPERTENSION CLINIC. P.C

MEDICARE: LANDMARK NEPHROLOGY & HYPERTENSION CLINIC. P.C
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
1261QM2500XMedical Specialty Clinic/Center25320AL

General Provider Information

NPI Number : 1265662720
Entity Type Code : Organization
Provider Name (Legal Business Name) : LANDMARK NEPHROLOGY & HYPERTENSION CLINIC. P.C
Provider Business Mailing Address
First Line : 4636 AMBERWOOD DR
Second Line :
City : ANNISTON
State : AL
Zip : 36207-7773
Country : US
Telephone Number : 256-283-9760
Fax Number :
Provider Business Practice Location Address
First Line : 210 NORTH ST W
Second Line : SUITE D
City : TALLADEGA
State : AL
Zip : 35160-2083
Country : US
Telephone Number : 256-283-9760
Fax Number :
Authorized Official
Title or Position : MD
Name : DR. UNINIBILE O ODAMA
Credential :
Telephone Number : 256-283-9760
Provider Enumeration Date : 07/18/2009
Last Update Date : 07/18/2009

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