Provider Demographics
NPI:1821695826
Name:PROVIDENCE KIDNEY & HYPERTENSION SPECIALISTS LLC
Entity Type:Organization
Organization Name:PROVIDENCE KIDNEY & HYPERTENSION SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-826-2914
Mailing Address - Street 1:1406 DICKERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1406 DICKERSON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1844
Practice Address - Country:US
Practice Address - Phone:917-926-2914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-03
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty