MEDICARE: CENTER FOR INTERNAL MEDICINE HYPER KIDNEY DISEASE & CRITICAL CARE 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	363LP2300X	Primary Care Nurse Practitioner	0101030754	VA

General Provider Information

NPI Number	:	1538348388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR INTERNAL MEDICINE HYPER KIDNEY DISEASE & CRITICAL CARE INC

Provider Business Mailing Address
First Line	:	110 N ROBINSON ST STE 305
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4461
Country	:	US
Telephone Number	:	804-780-2610
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 N ROBINSON ST STE 305
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4461
Country	:	US
Telephone Number	:	804-780-2610
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHRIDHAR VENKATRAMAN BHAT
Credential	:	M.D.
Telephone Number	:	804-780-2610

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	12/22/2014

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