1043255029 NPI number — NEPHROLOGY ASSOCIATES OF SARASOTA

Table of content: (NPI 1043255029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043255029 NPI number — NEPHROLOGY ASSOCIATES OF SARASOTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY ASSOCIATES OF SARASOTA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043255029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1921 WALDEMERE ST
Provider Second Line Business Mailing Address:
SUITE 413
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34239-2941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-917-6585
Provider Business Mailing Address Fax Number:
941-917-6514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1921 WALDEMERE ST
Provider Second Line Business Practice Location Address:
SUITE 413
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34239-2943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-917-6585
Provider Business Practice Location Address Fax Number:
941-917-6514
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GHOSE
Authorized Official First Name:
RANJAN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
941-917-6585

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C11284 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 99236 . This is a "BLUE CROSS BLUE SHEILD OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 62887500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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