Provider Demographics
NPI:1003233180
Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Other - Org Name:DIALYSIS CENTER AT VALLEYWISE COMPREHENSIVE CARE CENTER - PHOENIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-344-8178
Mailing Address - Street 1:PO BOX 29670
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9670
Mailing Address - Country:US
Mailing Address - Phone:602-344-8180
Mailing Address - Fax:
Practice Address - Street 1:2525 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4948
Practice Address - Country:US
Practice Address - Phone:602-344-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH3673261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ631935OtherAETNA
AZAZ0205850OtherBLUE CROSS BLUE SHIELD
AZAZ0947OtherHEALTHNET OF AZ
AZ500005OtherEVERCARE CHOICE
AZ29517OtherPHOENIX INDIAN MEDICAL CENTER
AZ189350800OtherUS DEPT OF LABOR
AZ987487Medicaid
AZ631935OtherAETNA