Provider Demographics
NPI:1346436532
Name:SOUTHWEST KIDNEY DIALYSIS, LLC
Entity Type:Organization
Organization Name:SOUTHWEST KIDNEY DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-610-6110
Mailing Address - Street 1:2149 E WARNER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3494
Mailing Address - Country:US
Mailing Address - Phone:480-610-6100
Mailing Address - Fax:480-610-6195
Practice Address - Street 1:10238 E. HAMPTON AVENUE
Practice Address - Street 2:SUITE 108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-610-6118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment