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CLINIC FOR KIDNEY DISEASES PA NPI 1467471672


NPI Information

NPI: 1467471672
Provider Name: CLINIC FOR KIDNEY DISEASES PA
Classification: Internal Medicine - 207RN0300X
Entity Type: Organization

Specialization: Nephrology

Address:
2585 HERSCHEL ST
JACKSONVILLE, FL
ZIP 32204
Phone: (904) 388-2678
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CLINIC FOR KIDNEY DISEASES PA is a nephrology internal medicine in Jacksonville, FL. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. CLINIC FOR KIDNEY DISEASES PA NPI is 1467471672. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2585 HERSCHEL ST
JACKSONVILLE, FL
ZIP 32204-557
Phone: (904) 388-2678
Fax: (904) 388-6776

The provider's authorized official is Dinesh Jayadevappa .
The authorized official title is President and has the following contact phone number (904) 388-2678.

The enumeration date for this NPI number is 7/19/2006 and was last updated on 1/20/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RN0300XInternal MedicineNephrologyME24762FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
199457MEDICARE ID-TYPE UNSPECIFIEDFLORIDAMEDICARE PART B GROUP #
2255215900MEDICAIDFLORIDA
399457OTHERFLORIDABCBS GROUP #
4B1063MEDICARE ID-TYPE UNSPECIFIEDFLORIDAR/R MEDICARE PART B GROUP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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