Provider Demographics
NPI:1881869832
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:BUSINESS MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-297-1158
Mailing Address - Street 1:100 W 3RD AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3260
Mailing Address - Country:US
Mailing Address - Phone:614-297-1158
Mailing Address - Fax:614-299-3406
Practice Address - Street 1:797 THOMAS LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3903
Practice Address - Country:US
Practice Address - Phone:614-447-0281
Practice Address - Fax:614-299-3406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN KIDNEY STONE MANANGEMENT LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0668AS261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center