Provider Demographics
NPI:1861496218
Name:KIDNEY TREATMENT OPTIONS, PC
Entity Type:Organization
Organization Name:KIDNEY TREATMENT OPTIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-748-7410
Mailing Address - Street 1:3209 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4638
Mailing Address - Country:US
Mailing Address - Phone:304-748-7410
Mailing Address - Fax:304-748-7411
Practice Address - Street 1:2700 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1158
Practice Address - Country:US
Practice Address - Phone:740-264-1318
Practice Address - Fax:740-264-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0703DC261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000378164OtherANTHEM BCBS
OH2474022Medicaid
WV3810001532Medicaid
WV390008192Medicare PIN
G05735Medicare UPIN
OH9326752Medicare PIN
OH2474022Medicaid
WVDN3452Medicare PIN
PA060131Medicare PIN
OH000000378164OtherANTHEM BCBS