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General NPI Number Information
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NPI Number | 1497231237
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Entity Type | Organization
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Legal Business Name | ARIZONA KIDNEY CARE LLC
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/21/2018
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Provider Practice Location Address
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Address Line | 2901 N STOCKTON HILL RD STE B
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City | KINGMAN
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State | AZ
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Zip | 86401
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Country | US
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Telephone | 928-718-0777
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Fax | 928-718-0877
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Provider Business Mailing Address
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Address Line | PO BOX 3837
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City | KINGMAN
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State | AZ
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Zip | 86402-3837
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Country | US
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Telephone | 928-718-0777
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Fax | 928-718-0877
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Authorized Official
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Title or Position | OWNER/MEMBER MANAGER
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Name | SHARMILA PARVATHANENI
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Credential | M.D.
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Telephone | 928-718-0777
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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 | 49359
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License Number State | AZ
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