Provider Demographics
NPI:1134192727
Name:NEPHROLOGY ASSOC OF SW OHIO INC
Entity type:Organization
Organization Name:NEPHROLOGY ASSOC OF SW OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAVALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-863-8212
Mailing Address - Street 1:3090 MCBRIDE COURT
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-0812
Mailing Address - Country:US
Mailing Address - Phone:513-863-8212
Mailing Address - Fax:513-863-8379
Practice Address - Street 1:3090 MCBRIDE COURT
Practice Address - Street 2:SUITE B
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-0812
Practice Address - Country:US
Practice Address - Phone:513-863-8212
Practice Address - Fax:513-863-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2288215Medicaid
OH2288215Medicaid