Provider Demographics
NPI:1568145985
Name:IRC-SCIONHEALTH SELMA LLC
Entity Type:Organization
Organization Name:IRC-SCIONHEALTH SELMA LLC
Other - Org Name:VAUGHAN KIDNEY CARE AN INNOVATIVE RENAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:1360 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36703-3210
Mailing Address - Country:US
Mailing Address - Phone:334-876-0076
Mailing Address - Fax:334-375-4049
Practice Address - Street 1:1360 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36703-3210
Practice Address - Country:US
Practice Address - Phone:334-876-0076
Practice Address - Fax:334-375-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment