Provider Demographics
NPI:1730284563
Name:NEPHROLOGY CONSULTANTS OF SOUTHEASTERN OHIO, INC.
Entity Type:Organization
Organization Name:NEPHROLOGY CONSULTANTS OF SOUTHEASTERN OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLIANY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:740-450-3400
Mailing Address - Street 1:3237 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1312
Mailing Address - Country:US
Mailing Address - Phone:740-450-3400
Mailing Address - Fax:740-450-3420
Practice Address - Street 1:3237 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1312
Practice Address - Country:US
Practice Address - Phone:740-450-3400
Practice Address - Fax:740-450-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2749799Medicaid
OH9363191Medicare PIN