MEDICARE: VALLEY KIDNEY ACCESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RI0011X	Interventional Cardiology Physician
2	207RN0300X	Nephrology Physician
3	2086S0129X	Vascular Surgery Physician
4	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1316361132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY KIDNEY ACCESS CENTER, LLC

Provider Business Mailing Address
First Line	:	1230 S CEDAR CREST BLVD
Second Line	:	SUITE 301
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6367
Country	:	US
Telephone Number	:	610-432-4529
Fax Number	:	610-432-2206

Provider Business Practice Location Address
First Line	:	2014 CITY LINE RD
Second Line	:	SUITE 101
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-2159
Country	:	US
Telephone Number	:	610-264-5199
Fax Number	:	610-264-5198

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAVINDRA BOLLU
Credential	:	MD
Telephone Number	:	610-432-4529

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	02/13/2014

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