Provider Demographics
NPI:1962569749
Name:SOUTHERN OHIO NEPHROLOGY, INC.
Entity type:Organization
Organization Name:SOUTHERN OHIO NEPHROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL-VARIATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-354-5393
Mailing Address - Street 1:1711 27TH ST
Mailing Address - Street 2:BRAUNLIN BLDG. (K) STE 301
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2654
Mailing Address - Country:US
Mailing Address - Phone:740-354-5393
Mailing Address - Fax:740-353-9068
Practice Address - Street 1:1711 27TH ST
Practice Address - Street 2:BRAUNLIN BLDG. (K) STE 301
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2654
Practice Address - Country:US
Practice Address - Phone:740-354-5393
Practice Address - Fax:740-353-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2222919Medicaid
OH9312681Medicare PIN