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NACOGDOCHES NEPHROLOGY PA NPI 1710120167


NPI Information

NPI: 1710120167
Provider Name: NACOGDOCHES NEPHROLOGY, PA
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
626 RUSSELL BLVD
SUITE B
NACOGDOCHES, TX
ZIP 75965
Phone: (936) 552-7216
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NACOGDOCHES NEPHROLOGY, PA is a specialist in Nacogdoches, TX. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. NACOGDOCHES NEPHROLOGY, PA NPI is 1710120167. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

626 RUSSELL BLVD
SUITE B
NACOGDOCHES, TX
ZIP 75965-246
Phone: (936) 552-7216
Fax: (936) 552-7274

The provider's authorized official is Dolamu O. B. Sokunbi .
The authorized official title is Nephrologist and has the following contact phone number (936) 552-7216.

The enumeration date for this NPI number is 4/15/2009 and was last updated on 4/15/2009.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistJ7203TEXASYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1F86783MEDICARE UPINTEXAS
2113679803MEDICAIDTEXAS

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: 5/5/2024

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