Provider Demographics
NPI:1023201928
Name:KIDNEY & HYPERTENSION SPECIALISTS OF CHILLICOTHE, LLC
Entity Type:Organization
Organization Name:KIDNEY & HYPERTENSION SPECIALISTS OF CHILLICOTHE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:COSENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-779-4340
Mailing Address - Street 1:P.O. BOX 141
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-0141
Mailing Address - Country:US
Mailing Address - Phone:740-779-4340
Mailing Address - Fax:740-774-4346
Practice Address - Street 1:4455 ST. RT. 159
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-779-4340
Practice Address - Fax:740-774-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003733207RN0300X
207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH295-55-75Medicaid
OH1074Medicaid
OHD97944Medicare UPIN
OH295-55-75Medicaid
KI9332771Medicare PIN