1366625006 NPI number — KIDNEY & HYPERTENSION CLINIC, INC

Table of content: (NPI 1366625006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366625006 NPI number — KIDNEY & HYPERTENSION CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY & HYPERTENSION CLINIC, 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:
1366625006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KIDNEY & HYPERTENSION CLINIC, INC.
Provider Second Line Business Mailing Address:
640 BOLTON ST
Provider Business Mailing Address City Name:
MARLBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01752-3999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-281-5953
Provider Business Mailing Address Fax Number:
508-299-2343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KIDNEY & HYPERTENSION CLINIC, INC.
Provider Second Line Business Practice Location Address:
640 BOLTON ST
Provider Business Practice Location Address City Name:
MARLBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01752-3999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-281-5953
Provider Business Practice Location Address Fax Number:
508-299-2343
Provider Enumeration Date:
12/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAHMUD
Authorized Official First Name:
HUMAIRA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
508-281-5953

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  154239 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A33542 . This is a "MEDICARE INDIVIDUAL PIN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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