MEDICARE: NORTH CAROLINA NEPHROLOGY PA

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	:	1932603800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CAROLINA NEPHROLOGY PA

Provider Business Mailing Address
First Line	:	3700 BARRETT DR STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7213
Country	:	US
Telephone Number	:	919-231-3966
Fax Number	:	919-231-3912

Provider Business Practice Location Address
First Line	:	2824 ROGERS RD STE 104
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3896
Country	:	US
Telephone Number	:	919-876-7807
Fax Number	:	919-876-8823

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JENNIFER CAPPS
Credential	:
Telephone Number	:	919-231-3966

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	09/19/2024

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