1366426801 NPI number — NEPHROLOGY ASSOCIATES INC

Table of content: (NPI 1366426801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366426801 NPI number — NEPHROLOGY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY ASSOCIATES INC
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:
1366426801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 WATERMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-438-5950
Provider Business Mailing Address Fax Number:
401-435-2561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 WATERMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914-3525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-438-5950
Provider Business Practice Location Address Fax Number:
401-435-2561
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
THURSBY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-438-5950

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: 110069682B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0025539 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110069682A , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: M13329 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M15273 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1366426801 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9736352 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 255 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9765972 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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