1952536278 NPI number — EAST VALLEY KIDNEY CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952536278 NPI number — EAST VALLEY KIDNEY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST VALLEY KIDNEY CENTER, INC.
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:
1952536278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3317 S HIGLEY RD
Provider Second Line Business Mailing Address:
SUITE 114-262
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85297-5436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-626-2020
Provider Business Mailing Address Fax Number:
480-626-2022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5432 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-2772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-626-2020
Provider Business Practice Location Address Fax Number:
480-626-2022
Provider Enumeration Date:
05/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GARG
Authorized Official First Name:
AMEESH
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-626-2020

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  29907 , 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)





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