Provider Demographics
NPI:1225292147
Name:NEPHROLOGY CONSULTANTS OF WESTERN KENTUCKY LLC
Entity Type:Organization
Organization Name:NEPHROLOGY CONSULTANTS OF WESTERN KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROGINEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-632-4221
Mailing Address - Street 1:1717 HIGH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-6300
Mailing Address - Country:US
Mailing Address - Phone:270-632-4221
Mailing Address - Fax:270-885-2041
Practice Address - Street 1:1717 HIGH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6300
Practice Address - Country:US
Practice Address - Phone:270-632-4221
Practice Address - Fax:270-885-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000599078OtherANTHEM BCBS
KY7100045160Medicaid
00730Medicare PIN