1922183045 NPI number — KIDNEY INSTITUTE AT EMC LLC

Table of content: (NPI 1922183045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922183045 NPI number — KIDNEY INSTITUTE AT EMC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY INSTITUTE AT EMC 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:
1922183045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39000 BOB HOPE DR
Provider Second Line Business Mailing Address:
STE. P-103
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-837-9696
Provider Business Mailing Address Fax Number:
760-837-9984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39000 BOB HOPE DR
Provider Second Line Business Practice Location Address:
STE. P-103
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-837-9696
Provider Business Practice Location Address Fax Number:
760-837-9984
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHANDRASHEKAR
Authorized Official First Name:
JAMBUR
Authorized Official Middle Name:
ERIAH
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
760-837-9696

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CDC02832F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com