1023201928 NPI number — KIDNEY & HYPERTENSION SPECIALISTS OF CHILLICOTHE, LLC

Table of content: (NPI 1023201928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023201928 NPI number — KIDNEY & HYPERTENSION SPECIALISTS OF CHILLICOTHE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY & HYPERTENSION SPECIALISTS OF CHILLICOTHE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023201928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 141
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ALBANY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43054-0141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-779-4340
Provider Business Mailing Address Fax Number:
740-774-4346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4455 ST. RT. 159
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-779-4340
Provider Business Practice Location Address Fax Number:
740-774-4346
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COSENTINO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
740-779-4340

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  34003733 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 295-55-75 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1074 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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