Provider Demographics
NPI:1700074770
Name:CLEVELAND KIDNEY & HYPERTENSION CONSULTANTS INC
Entity Type:Organization
Organization Name:CLEVELAND KIDNEY & HYPERTENSION CONSULTANTS INC
Other - Org Name:CKHC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-261-6263
Mailing Address - Street 1:25301 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2609
Mailing Address - Country:US
Mailing Address - Phone:216-261-6263
Mailing Address - Fax:216-262-4964
Practice Address - Street 1:25301 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2609
Practice Address - Country:US
Practice Address - Phone:216-261-6263
Practice Address - Fax:216-262-4964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2784876Medicaid
OH2784876Medicaid