MEDICARE: KIDNEY COUNSELOR,LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	270	AL

General Provider Information

NPI Number	:	1568560696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY COUNSELOR,LLC

Provider Business Mailing Address
First Line	:	207 ARROWHEAD DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-4105
Country	:	US
Telephone Number	:	334-202-4342
Fax Number	:	334-277-8929

Provider Business Practice Location Address
First Line	:	4163 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2881
Country	:	US
Telephone Number	:	334-396-5570
Fax Number	:	334-396-5572

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. CECILIA COOK DALTON IX
Credential	:	R.D.,L.D.
Telephone Number	:	334-202-4342

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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Directions to “KIDNEY COUNSELOR,LLC ” Practice Location

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