Healthcare Provider Details

I. General information

NPI: 1871503268
Provider Name (Legal Business Name): KIDNEY CARE CENTER,P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE STE 524B
MEMPHIS TN
38119-5215
US

IV. Provider business mailing address

PO BOX 343369
MEMPHIS TN
38184-3369
US

V. Phone/Fax

Practice location:
  • Phone: 901-684-3955
  • Fax: 901-684-3956
Mailing address:
  • Phone: 901-684-3955
  • Fax: 901-684-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMEEZ U. DIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 901-684-3955