Northeast Renal & Dialysis, a Professional Medical Corporation

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

MD.204452 Issued in LA

Legal business name

NORTHEAST RENAL & DIALYSIS, A PROFESSIONAL MEDICAL CORPORATION

Practice address

1908 Royal Ave
Monroe, LA 71201-5724

Phone

(318) 325-5435

Fax

(318) 325-8852

NPI assigned

Mar 14, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David Earl Pruett, M.D.

Title

President/Owner

Phone

(318) 325-5435

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413936000000",
    "number": "1578989505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1908 ROYAL AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015724",
            "telephone_number": "318-325-5435",
            "fax_number": "318-325-8852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 ROYAL AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015724",
            "telephone_number": "318-325-5435",
            "fax_number": "318-325-8852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST RENAL & DIALYSIS, A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-14",
        "last_updated": "2014-10-22",
        "status": "A",
        "authorized_official_last_name": "PRUETT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "318-325-5435",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "LA",
            "license": "MD.204452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2152203",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in Monroe, LA
• Providers in Monroe, LA by specialty
• Nephrology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.