Provider Demographics
NPI: | 1720269053 |
---|---|
Name: | AKDHC, LLC |
Entity Type: | Organization |
Organization Name: | AKDHC, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CREDENTIALING ADMINISTRATOR |
Authorized Official - Prefix: | MS |
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 |
Mailing Address - Street 2: | #400 |
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: | 1003 DIVISION ST |
Practice Address - Street 2: | STE 5 |
Practice Address - City: | PRESCOTT |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 86301-1657 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-445-7632 |
Practice Address - Fax: | 928-445-9283 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-11-15 |
Last Update Date: | 2011-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 66686 | Medicare PIN |