Provider Demographics
NPI: | 1356879902 |
---|---|
Name: | NEPHROLOGY AND HYPERTENSION MEDICAL ASSOCIATES PC |
Entity type: | Organization |
Organization Name: | NEPHROLOGY AND HYPERTENSION MEDICAL ASSOCIATES PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OPERATIONS MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TRISH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ROTUREAU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 912-354-4813 |
Mailing Address - Street 1: | PO BOX 15238 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAVANNAH |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31416-1938 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 912-354-4813 |
Mailing Address - Fax: | 912-354-7569 |
Practice Address - Street 1: | 3025 SHRINE RD |
Practice Address - Street 2: | |
Practice Address - City: | BRUNSWICK |
Practice Address - State: | GA |
Practice Address - Zip Code: | 31520-4784 |
Practice Address - Country: | US |
Practice Address - Phone: | 912-354-4813 |
Practice Address - Fax: | 912-354-7569 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-05-26 |
Last Update Date: | 2017-05-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |