Provider Demographics
NPI:1043610819
Name:THE KIDNEY CARE CENTER, LLC
Entity Type:Organization
Organization Name:THE KIDNEY CARE CENTER, LLC
Other - Org Name:THE KIDNEY CARE CENTER - HOBBS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHONTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-0906
Mailing Address - Street 1:1126 SLIDE RD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5402
Mailing Address - Country:US
Mailing Address - Phone:806-771-0906
Mailing Address - Fax:806-771-0896
Practice Address - Street 1:3921 N. CALLE GRANDE
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0954
Practice Address - Country:US
Practice Address - Phone:575-738-0400
Practice Address - Fax:575-738-0402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE KIDNEY CARE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-29
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3538OtherNEW MEXICO DEPARTMENT OF HEALTH