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General NPI Number Information
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NPI Number | 1134426893
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Entity Type | Organization
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Legal Business Name | SOUTHWEST KIDNEY INSTITUTE VASCULAR CENTER LLC
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 1100 E UNIVERSITY DR
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City | TEMPE
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State | AZ
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Zip | 85281-8401
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Country | US
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Telephone | 602-277-4429
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 N 3RD ST
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City | PHOENIX
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State | AZ
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Zip | 85004-1153
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Country | US
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Telephone | 602-277-4429
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY COOPER
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Credential | MD
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Telephone | 602-277-4429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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