Provider Demographics
NPI:1659552479
Name:AKDHC, LLC
Entity Type:Organization
Organization Name:AKDHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:602-351-3015
Mailing Address - Street 1:3003 N CENTRAL AVE #400
Mailing Address - Street 2:AKDHC
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1041 HANCOCK RD, STE A
Practice Address - Street 2:AKDHC, LLC
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-0000
Practice Address - Country:US
Practice Address - Phone:928-704-7011
Practice Address - Fax:928-704-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28479Medicare PIN