Basic Information
| Provider Information | |||||||||
| NPI: | 1881869832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN KIDNEY STONE MANAGEMENT LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 W 3RD AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432013260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142971158 | ||||||||
| FaxNumber: | 6142993406 | ||||||||
| Practice Location | |||||||||
| Address1: | 797 THOMAS LN | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144470281 | ||||||||
| FaxNumber: | 6142993406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 04/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | FOUST | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANANGER | ||||||||
| AuthorizedOfficialTelephone: | 6142971158 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMERICAN KIDNEY STONE MANANGEMENT LTD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 0668AS | OH | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.