1811278161 NPI number — KIDNEY AND HYPERTENSION CLINIC OF ALASKA LLC

Table of content: (NPI 1811278161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811278161 NPI number — KIDNEY AND HYPERTENSION CLINIC OF ALASKA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY AND HYPERTENSION CLINIC OF ALASKA 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:
1811278161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7650 SE 27TH ST
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
MERCER ISLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98040-3060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-816-6506
Provider Business Mailing Address Fax Number:
866-703-0897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 PROVIDENCE DR
Provider Second Line Business Practice Location Address:
BUILDING B, SUITE 02
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-4671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-375-5200
Provider Business Practice Location Address Fax Number:
866-703-0897
Provider Enumeration Date:
08/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PARDO
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
206-816-6506

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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