Provider Demographics
NPI:1053506444
Name:HYPERTENSION AND KIDNEY CENTER, P.C.
Entity type:Organization
Organization Name:HYPERTENSION AND KIDNEY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LENEWEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-337-6500
Mailing Address - Street 1:851 MAIN ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:S WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1612
Mailing Address - Country:US
Mailing Address - Phone:781-337-6500
Mailing Address - Fax:781-331-1148
Practice Address - Street 1:851 MAIN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:S WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1612
Practice Address - Country:US
Practice Address - Phone:781-337-6500
Practice Address - Fax:781-331-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38013207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9724001Medicaid
MAB73353Medicare UPIN