Provider Demographics
NPI:1326157462
Name:KIDNEY CARE INC
Entity Type:Organization
Organization Name:KIDNEY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KUEHNEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-256-0877
Mailing Address - Street 1:10201 SE MAIN ST
Mailing Address - Street 2:SUITE 27
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2937
Mailing Address - Country:US
Mailing Address - Phone:503-256-0877
Mailing Address - Fax:503-256-4188
Practice Address - Street 1:10201 SE MAIN ST
Practice Address - Street 2:SUITE 27
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2937
Practice Address - Country:US
Practice Address - Phone:503-256-0877
Practice Address - Fax:503-256-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR101055Medicare ID - Type Unspecified