Healthcare Provider Details

I. General information

NPI: 1194744201
Provider Name (Legal Business Name): KIDNEY & HYPERTENSION ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W HIGH ST SUITE 150
LIMA OH
45801-2969
US

IV. Provider business mailing address

750 W HIGH ST SUITE 150
LIMA OH
45801-2969
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-1359
  • Fax: 419-227-7586
Mailing address:
  • Phone: 419-227-1359
  • Fax: 419-227-7586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2054539
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: DR. DAVID L IMLER
Title or Position: PHYSICIAN ADMINISTRATOR
Credential: D.O.
Phone: 419-227-1359