Provider Demographics
NPI:1316913445
Name:SELMA NEPHROLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:SELMA NEPHROLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-874-6053
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-0384
Mailing Address - Country:US
Mailing Address - Phone:334-874-6053
Mailing Address - Fax:334-418-0726
Practice Address - Street 1:905 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6746
Practice Address - Country:US
Practice Address - Phone:334-874-6053
Practice Address - Fax:334-418-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9217207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALTA000005679Medicaid
AL51517691OtherBLUE CROSS PROVIDER #
ALSE528700710Medicaid
ALTA000075573Medicaid
AL051075573OtherBLUE CROSS PROVIDER #
AL051005679OtherBLUE CROSS PROVIDER #
ALTA009931425Medicaid
ALTA009931425Medicaid
ALC76968Medicare UPIN
AL000005679Medicare ID - Type UnspecifiedPROVIDER #
AL051005679OtherBLUE CROSS PROVIDER #
ALTA000005679Medicaid