Healthcare Provider Details

I. General information

NPI: 1497101935
Provider Name (Legal Business Name): KIDNEY CARE CENTER NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 ANTHONY DR STE 3A
ANTHONY NM
88021-9346
US

IV. Provider business mailing address

PO BOX 3877
JOLIET IL
60434-3877
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-6830
  • Fax: 815-741-6832
Mailing address:
  • Phone: 815-741-6830
  • Fax: 815-741-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MORUFU ALAUSA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 815-741-6830