MEDICARE: THE CENTER FOR RENAL MEDICINE, 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF9221	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	382729	OTHER	VA	ANTHEM BLUE CROSS OF VA

General Provider Information

NPI Number	:	1730104647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR RENAL MEDICINE, INC.

Provider Business Mailing Address
First Line	:	739 THIMBLE SHOALS BLVD
Second Line	:	SUITE 801
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-3562
Country	:	US
Telephone Number	:	757-873-1009
Fax Number	:	757-873-7689

Provider Business Practice Location Address
First Line	:	739 THIMBLE SHOALS BLVD
Second Line	:	SUITE 801
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-3562
Country	:	US
Telephone Number	:	757-873-1009
Fax Number	:	757-873-7689

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN C GRETES
Credential	:	M.D.
Telephone Number	:	757-873-1009

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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