1578058939 NPI number — NEPHROLOGY CONSULTANTS OF JACKSONVILLE LLC

Table of content: (NPI 1578058939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578058939 NPI number — NEPHROLOGY CONSULTANTS OF JACKSONVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY CONSULTANTS OF JACKSONVILLE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1578058939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1633 CHURCH ST STE 500, PHYSICIAN PRACTICE DIVISION
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-327-3061
Provider Business Mailing Address Fax Number:
615-329-2513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3129 HENDRICKS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-398-8266
Provider Business Practice Location Address Fax Number:
904-396-4803
Provider Enumeration Date:
06/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
DONOVAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-327-3061

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)





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