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:COO
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:913-232-1472
Mailing Address - Street 1:1600 STOUT ST STE 2000
Mailing Address - Street 2:ATTN STRIVE HEALTH CREDENTIALING TEAM
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3113
Mailing Address - Country:US
Mailing Address - Phone:980-443-4852
Mailing Address - Fax:
Practice Address - Street 1:1320 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3266
Practice Address - Country:US
Practice Address - Phone:980-443-4852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center