=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558361550
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHMOND NEPHROLOGY & HYPERTENSION PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2005
-----------------------------------------------------
Last Update Date | 06/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1036 CENTER DRIVE, SUITE A
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-3838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-626-1700
-----------------------------------------------------
Fax | 859-626-1702
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1036 CENTER DRIVE, SUITE A
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-3838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-626-1700
-----------------------------------------------------
Fax | 859-626-1702
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | RIZWAN AKHTAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 859-626-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 173647
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 34262
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------