1568876324 NPI number — SUN CITY KIDNEY, PA

Table of content: (NPI 1568876324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568876324 NPI number — SUN CITY KIDNEY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUN CITY KIDNEY, PA
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:
1568876324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 E CLIFF DR
Provider Second Line Business Mailing Address:
SUITE 3E
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-626-5548
Provider Business Mailing Address Fax Number:
915-626-5411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 E CLIFF DR
Provider Second Line Business Practice Location Address:
SUITE 3E
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-626-5548
Provider Business Practice Location Address Fax Number:
915-626-5411
Provider Enumeration Date:
06/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ROSARIO
Authorized Official First Name:
REY
Authorized Official Middle Name:
FRANCISCO
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
915-626-5548

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  M1325 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1033103080 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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