Provider Demographics
NPI:1811278161
Name:KIDNEY AND HYPERTENSION CLINIC OF ALASKA LLC
Entity type:Organization
Organization Name:KIDNEY AND HYPERTENSION CLINIC OF ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-816-6506
Mailing Address - Street 1:7650 SE 27TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3060
Mailing Address - Country:US
Mailing Address - Phone:206-816-6506
Mailing Address - Fax:866-703-0897
Practice Address - Street 1:3300 PROVIDENCE DR
Practice Address - Street 2:BUILDING B, SUITE 02
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4671
Practice Address - Country:US
Practice Address - Phone:907-375-5200
Practice Address - Fax:866-703-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty