Provider Demographics
NPI:1508009101
Name:HYPERTENSION AND KIDNEY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:HYPERTENSION AND KIDNEY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TEFERI
Authorized Official - Middle Name:G
Authorized Official - Last Name:MENGESHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-367-1004
Mailing Address - Street 1:PO BOX 636316
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:614-451-8770
Mailing Address - Fax:614-451-2291
Practice Address - Street 1:2355 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4305
Practice Address - Country:US
Practice Address - Phone:614-367-1004
Practice Address - Fax:614-367-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084770207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9381061Medicare PIN