Diversified Renal Group Llc

LBN: Diversified Renal Group Llc
Diversified Renal Group Llc is an health care organization with primary practice located at 5903 Ridgewood Rd Ste 340, Jackson MS 39211. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as the primary health care specialty. Diversified Renal Group Llc can be contacted via phone (601) 899-3340, or through Davis, Gary M via phone (601) 899-3340.

Contact Information

Primary practice address
5903 Ridgewood Rd Ste 340 Jackson MS 39211
Phone: (601) 899-3340
Fax: (601) 899-3343
Website:
Map and Directions
Authorized official contact:
Name: Davis, Gary M Doctor of Medicine (MD)
Phone: (601) 899-3340

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X

Profile Details

NPI number 1184792038
LBN Legal business name Diversified Renal Group Llc
DBA Doing business as
Authorized official Davis, Gary M Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 30th, 2006
Last updated Apr 25th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184792038 NPPES
Mississippi MEDICAID 09014813

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