Provider Demographics
NPI:1396182788
Name:KIDNEY AND HYPERTENSION CENTER OF WABASH VALLEY, LLC
Entity Type:Organization
Organization Name:KIDNEY AND HYPERTENSION CENTER OF WABASH VALLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GAURAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-244-9104
Mailing Address - Street 1:1801 N 6TH ST
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4086
Mailing Address - Country:US
Mailing Address - Phone:812-238-4708
Mailing Address - Fax:
Practice Address - Street 1:1801 N 6TH ST
Practice Address - Street 2:SUITE # 200
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4086
Practice Address - Country:US
Practice Address - Phone:812-238-4708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-27
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067346A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty