Provider Demographics
NPI:1124038963
Name:KIDNEY SPECIALISTS, INC.
Entity Type:Organization
Organization Name:KIDNEY SPECIALISTS, INC.
Other - Org Name:KIDNEY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-823-8500
Mailing Address - Street 1:595 COPELAND MILL RD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8908
Mailing Address - Country:US
Mailing Address - Phone:614-823-8500
Mailing Address - Fax:614-823-8501
Practice Address - Street 1:595 COPELAND MILL RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8908
Practice Address - Country:US
Practice Address - Phone:614-823-8500
Practice Address - Fax:614-823-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2411303Medicaid
OH2436055Medicaid
OH2446884Medicaid
OH2436082Medicaid
OH2436117Medicaid
OH2436117Medicaid
OH9334784Medicare PIN
OH2436082Medicaid
OH9334781Medicare PIN
OH9334785Medicare PIN