Provider Demographics
NPI:1558361550
Name:RICHMOND NEPHROLOGY & HYPERTENSION PSC
Entity Type:Organization
Organization Name:RICHMOND NEPHROLOGY & HYPERTENSION PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIZWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-626-1700
Mailing Address - Street 1:1036 CENTER DRIVE, SUITE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3838
Mailing Address - Country:US
Mailing Address - Phone:859-626-1700
Mailing Address - Fax:859-626-1702
Practice Address - Street 1:1036 CENTER DRIVE, SUITE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3838
Practice Address - Country:US
Practice Address - Phone:859-626-1700
Practice Address - Fax:859-626-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173647207R00000X
KY34262207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100027550Medicaid
KY64342264Medicaid
KY64342264Medicaid
KYDG6571Medicare PIN
KY7330Medicare PIN
G18876Medicare UPIN