Provider Demographics
NPI:1780025213
Name:SOUTHEAST IOWA KIDNEY CARE, HYPERTENSION AND MEDICINE CLINIC, LLC
Entity Type:Organization
Organization Name:SOUTHEAST IOWA KIDNEY CARE, HYPERTENSION AND MEDICINE CLINIC, LLC
Other - Org Name:JASHIM UDDIN AHMED
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JASHIM
Authorized Official - Middle Name:UDDIN
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-682-4557
Mailing Address - Street 1:641 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2116
Mailing Address - Country:US
Mailing Address - Phone:641-682-4557
Mailing Address - Fax:
Practice Address - Street 1:641 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2116
Practice Address - Country:US
Practice Address - Phone:641-682-4557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33195207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty