Provider Demographics
NPI:1851420491
Name:AMERICAN KIDNEY STONE MANAGEMENT LTD
Entity Type:Organization
Organization Name:AMERICAN KIDNEY STONE MANAGEMENT LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-298-8150
Mailing Address - Street 1:100 W 3RD AVE
Mailing Address - Street 2:STE 350
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3256
Mailing Address - Country:US
Mailing Address - Phone:614-298-8150
Mailing Address - Fax:614-291-9452
Practice Address - Street 1:100 W 3RD AVE
Practice Address - Street 2:STE 350
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3256
Practice Address - Country:US
Practice Address - Phone:614-298-8150
Practice Address - Fax:614-291-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000231421OtherANTHEM
OH=========002OtherMEDICAL MUTUAL MMD