1093201246 NPI number — CENTRAL OHIO NEPHROLOGY AND HYPERTENSION CLINIC LLC

Table of content: (NPI 1093201246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093201246 NPI number — CENTRAL OHIO NEPHROLOGY AND HYPERTENSION CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OHIO NEPHROLOGY AND HYPERTENSION CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1093201246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
691 SOUTHBLUFF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-8605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-423-8506
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 S CLEVELAND AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43081-8958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-745-9468
Provider Business Practice Location Address Fax Number:
877-538-7923
Provider Enumeration Date:
07/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MURITHI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
614-745-9468

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  201815201106 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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