Provider Demographics
NPI:1952498347
Name:OHIO VALLEY NEPHROLOGY ASSOCIATES PSC
Entity Type:Organization
Organization Name:OHIO VALLEY NEPHROLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-689-1919
Mailing Address - Street 1:1930 E PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1443
Mailing Address - Country:US
Mailing Address - Phone:270-689-1919
Mailing Address - Fax:270-689-1990
Practice Address - Street 1:1930 E PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1443
Practice Address - Country:US
Practice Address - Phone:270-689-1919
Practice Address - Fax:270-689-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941023Medicaid
KY204443900OtherFEDERAL BLACK LUNG
KYCJ7612OtherMEDICARE RAILROAD
IN249200Medicare PIN
KY204443900OtherFEDERAL BLACK LUNG
KY6350Medicare PIN
IN189220Medicare PIN