Provider Demographics
NPI:1255509469
Name:KIDNEY & HYPERTENSION INSTITUTE OF ST. GEORGE PLLC
Entity Type:Organization
Organization Name:KIDNEY & HYPERTENSION INSTITUTE OF ST. GEORGE PLLC
Other - Org Name:SOUTHERN UTAH KIDNEY & HYPERTENSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-652-1135
Mailing Address - Street 1:301 N 200 E
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3010
Mailing Address - Country:US
Mailing Address - Phone:435-652-1135
Mailing Address - Fax:435-652-1190
Practice Address - Street 1:1127 BROADWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3519
Practice Address - Country:US
Practice Address - Phone:206-816-6535
Practice Address - Fax:206-816-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6787613-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I38885Medicare UPIN