Provider Demographics
NPI:1497231237
Name:ARIZONA KIDNEY CARE LLC
Entity Type:Organization
Organization Name:ARIZONA KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARVATHANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-718-0777
Mailing Address - Street 1:PO BOX 3837
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-3837
Mailing Address - Country:US
Mailing Address - Phone:928-718-0777
Mailing Address - Fax:928-718-0877
Practice Address - Street 1:2901 N STOCKTON HILL RD STE B
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401
Practice Address - Country:US
Practice Address - Phone:928-718-0777
Practice Address - Fax:928-718-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49359207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty