Provider Demographics
NPI:1215981147
Name:NEPHROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:NEPHROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:P
Authorized Official - Last Name:GEORGIEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-496-7002
Mailing Address - Street 1:PO BOX 3471
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0471
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:6709 S. MINNESOTA AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2593
Practice Address - Country:US
Practice Address - Phone:605-496-7002
Practice Address - Fax:877-543-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12435Medicaid
MN14G06JEOtherBCBS - GROUP
SDCH3926OtherRAILROAD MEDICARE
SD4997595OtherBCBS - GROUP
NE10025031900Medicaid
MN628286500Medicaid
SD4997595OtherBCBS - GROUP
NE099283Medicare PIN
ND12435Medicaid
NE10025031900Medicaid