Provider Demographics
NPI:1982741971
Name:THE KIDNEY GROUP, INC
Entity Type:Organization
Organization Name:THE KIDNEY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-746-1488
Mailing Address - Street 1:1340 BELMONT AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1125
Mailing Address - Country:US
Mailing Address - Phone:330-746-1488
Mailing Address - Fax:330-746-0384
Practice Address - Street 1:1340 BELMONT AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1125
Practice Address - Country:US
Practice Address - Phone:330-746-1488
Practice Address - Fax:330-746-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH952644174400000X
207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH099187OtherHIGHMARK
PA202550OtherUPMC
PA0009994970002Medicaid
OH0630213Medicaid
PA824865OtherHIGHMARK
PA1502089OtherGATEWAY
PA824865OtherHIGHMARK
PA743581Medicare ID - Type UnspecifiedPA MEDICARE
OHCD6015Medicare ID - Type UnspecifiedMEDICARE RAILROAD
PA0009994970002Medicaid