Provider Demographics
NPI:1902975824
Name:COMPREHENSIVE KIDNEY CARE, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE KIDNEY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FLAUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-292-0226
Mailing Address - Street 1:19133 HILLIARD BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2907
Mailing Address - Country:US
Mailing Address - Phone:216-228-5500
Mailing Address - Fax:216-227-2628
Practice Address - Street 1:19133 HILLIARD BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2907
Practice Address - Country:US
Practice Address - Phone:216-228-5500
Practice Address - Fax:216-227-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-072868A207R00000X
OH34-006702F207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2491183Medicaid
OHDC0629OtherRAILROAD MEDICARE
OHP00233217OtherRAILROAD MEDICARE
OHP00157422OtherRAILROAD MEDICARE
OHP00368220OtherRAILROAD MEDICARE
OHP00145696OtherRAILROAD MEDICARE
OH9345131Medicare PIN