Provider Demographics
NPI:1033158829
Name:KIDNEY DISEASE AND HYPERTENSION ASSOCIATES, INC.
Entity Type:Organization
Organization Name:KIDNEY DISEASE AND HYPERTENSION ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-489-0220
Mailing Address - Street 1:506 ATHENA DR
Mailing Address - Street 2:PO BOX 98
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1005
Mailing Address - Country:US
Mailing Address - Phone:724-468-6869
Mailing Address - Fax:724-468-6207
Practice Address - Street 1:419 COYLE CURTAIN RD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-3515
Practice Address - Country:US
Practice Address - Phone:724-489-0220
Practice Address - Fax:724-489-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA564114Medicare ID - Type Unspecified