=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730284563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEPHROLOGY CONSULTANTS OF SOUTHEASTERN OHIO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 12/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3089 MAPLE AVE
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-450-3400
-----------------------------------------------------
Fax | 740-450-3420
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3089 MAPLE AVE
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-450-3400
-----------------------------------------------------
Fax | 740-450-3420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MELISSA LISTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-450-3400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------