Provider Demographics
NPI:1215719794
Name:INNONEPH LLC
Entity type:Organization
Organization Name:INNONEPH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PEPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-890-6456
Mailing Address - Street 1:1299 FARNAM ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1857
Mailing Address - Country:US
Mailing Address - Phone:712-796-2545
Mailing Address - Fax:844-717-0585
Practice Address - Street 1:17410 BURKE ST STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2250
Practice Address - Country:US
Practice Address - Phone:531-444-4757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty