1407800212 NPI number — VALLEY KIDNEY INSTITUTE LLC

Table of content: (NPI 1407800212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407800212 NPI number — VALLEY KIDNEY INSTITUTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY KIDNEY INSTITUTE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407800212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5150 N 16TH ST
Provider Second Line Business Mailing Address:
STE B232
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-3990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-977-1331
Provider Business Mailing Address Fax Number:
623-977-1449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13943 N 91ST AVE
Provider Second Line Business Practice Location Address:
STE H-101
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-3689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-977-1331
Provider Business Practice Location Address Fax Number:
623-977-1449
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAI
Authorized Official First Name:
ANUP
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
623-977-1331

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  41789 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 430888 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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