Healthcare Provider Details

I. General information

NPI: 1497231237
Provider Name (Legal Business Name): ARIZONA KIDNEY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 N STOCKTON HILL RD STE B
KINGMAN AZ
86401
US

IV. Provider business mailing address

PO BOX 3837
KINGMAN AZ
86402-3837
US

V. Phone/Fax

Practice location:
  • Phone: 928-718-0777
  • Fax: 928-718-0877
Mailing address:
  • Phone: 928-718-0777
  • Fax: 928-718-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number49359
License Number StateAZ

VIII. Authorized Official

Name: SHARMILA PARVATHANENI
Title or Position: OWNER/MEMBER MANAGER
Credential: M.D.
Phone: 928-718-0777