Provider Demographics
NPI:1023399458
Name:RENAL SPECIALISTS OF KENTUCKY PSC
Entity Type:Organization
Organization Name:RENAL SPECIALISTS OF KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:V
Authorized Official - Last Name:ARNDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-437-5161
Mailing Address - Street 1:77 MACK WALTERS RD
Mailing Address - Street 2:STE 300
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1789
Mailing Address - Country:US
Mailing Address - Phone:502-437-5161
Mailing Address - Fax:502-437-5163
Practice Address - Street 1:77 MACK WALTERS RD
Practice Address - Street 2:STE 300
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1789
Practice Address - Country:US
Practice Address - Phone:502-437-5161
Practice Address - Fax:502-437-5163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41829207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100182040Medicaid
KYK015340Medicare PIN