Provider Demographics
NPI:1699874222
Name:NEPHROLOGY CONSULTANTS LLC
Entity type:Organization
Organization Name:NEPHROLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-533-4626
Mailing Address - Street 1:2780 BOB WALLACE AVE SW
Mailing Address - Street 2:SUITE E
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4104
Mailing Address - Country:US
Mailing Address - Phone:256-533-4626
Mailing Address - Fax:256-533-4710
Practice Address - Street 1:2780 BOB WALLACE AVE SW
Practice Address - Street 2:SUITE E
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4104
Practice Address - Country:US
Practice Address - Phone:256-533-4626
Practice Address - Fax:256-533-4710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529403230Medicaid
AL529403230Medicaid