Healthcare Provider Details

I. General information

NPI: 1730795501
Provider Name (Legal Business Name): SOUTHWEST KIDNEY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5981 JEFFERSON ST NE STE A
ALBUQUERQUE NM
87109-3457
US

IV. Provider business mailing address

PO BOX 22566
SANTA FE NM
87502-2566
US

V. Phone/Fax

Practice location:
  • Phone: 505-370-9600
  • Fax: 505-355-0566
Mailing address:
  • Phone: 505-370-9600
  • Fax: 505-355-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BIJU CHERIAN
Title or Position: TREASURER/OWNER
Credential: MD
Phone: 505-370-9600