Provider Demographics
NPI:1386068112
Name:PENNYRILE NEPHROLOGY ASSOCIATES, PSC
Entity type:Organization
Organization Name:PENNYRILE NEPHROLOGY ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-821-5726
Mailing Address - Street 1:1020 WATERFALL CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8079
Mailing Address - Country:US
Mailing Address - Phone:270-821-5726
Mailing Address - Fax:270-326-2090
Practice Address - Street 1:1020 WATERFALL CT
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-8079
Practice Address - Country:US
Practice Address - Phone:270-821-5726
Practice Address - Fax:270-326-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
207RN0300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100284170Medicaid