DIVERSIFIED RENAL GROUP LLC – NPI #1184792038
Internal Medicine

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

DIVERSIFIED RENAL GROUP LLC is a provider located in JACKSON, MS. NPPES has assigned the NPI number 1184792038 to DIVERSIFIED RENAL GROUP LLC on November 30, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 207RN0300X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Nephrology

The NPI profile was previously updated about 18 years ago on Apr 25, 2008. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for DIVERSIFIED RENAL GROUP LLC below.

NPI Profile for
DIVERSIFIED RENAL GROUP LLC

NPI Number
1184792038
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
DIVERSIFIED RENAL GROUP LLC
Primary location
5903 RIDGEWOOD RD
STE 340
JACKSON, MS 39211
Phone: (601) 899-3340 Fax: (601) 899-3343
Mailing address
PO BOX 2057
RIDGELAND, MS 39158
Phone: (601) 899-3340 Fax: (601) 899-3343
Organization Subpart
No
Authorized Official
GARY DAVIS
MEMBER
Phone: (601) 899-3340
Updated
Identifiers

Identifiers for DIVERSIFIED RENAL GROUP LLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDMS09014813
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207RN0300X
- Internal Medicine / Nephrology (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.