MEDICARE: NEPHROLOGY NURSING SERVICE 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		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528066818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPHROLOGY NURSING SERVICE INC.

Provider Business Mailing Address
First Line	:	8TH ST. & GIRARD AVENUE
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122
Country	:	US
Telephone Number	:	215-787-2278
Fax Number	:	215-787-2171

Provider Business Practice Location Address
First Line	:	8TH ST. AT GIRARD AVE.
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122
Country	:	US
Telephone Number	:	215-787-2278
Fax Number	:	215-787-2171

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. PATRICIA CLARK
Credential	:
Telephone Number	:	215-787-2278

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/21/2022

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