Provider Demographics
NPI:1679916001
Name:INTEGRATED MEDICAL CARE AND NEPHROLOGY LLC
Entity type:Organization
Organization Name:INTEGRATED MEDICAL CARE AND NEPHROLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-757-9731
Mailing Address - Street 1:6925 SHORE TER
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4675
Mailing Address - Country:US
Mailing Address - Phone:317-290-8288
Mailing Address - Fax:317-290-8801
Practice Address - Street 1:6925 SHORE TER
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4675
Practice Address - Country:US
Practice Address - Phone:317-290-8288
Practice Address - Fax:317-290-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061402A261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1679916001OtherNPI