Provider Demographics
NPI:1477155638
Name:PENNSYLVANIA KIDNEY CARE, P.C.
Entity Type:Organization
Organization Name:PENNSYLVANIA KIDNEY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLITOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-204-5760
Mailing Address - Street 1:1600 STOUT ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3508 MARKET ST STE 213
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3320
Practice Address - Country:US
Practice Address - Phone:270-240-2585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center