Healthcare Provider Details

I. General information

NPI: 1952498347
Provider Name (Legal Business Name): OHIO VALLEY NEPHROLOGY ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E PARRISH AVE
OWENSBORO KY
42303-1443
US

IV. Provider business mailing address

1930 E PARRISH AVE
OWENSBORO KY
42303-1443
US

V. Phone/Fax

Practice location:
  • Phone: 270-689-1919
  • Fax: 270-689-1990
Mailing address:
  • Phone: 270-689-1919
  • Fax: 270-689-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. MAHENDRA C MARU
Title or Position: PRESIDENT
Credential: MD
Phone: 270-689-1919