MEDICARE: SOUTHWEST KIDNEY INSTITUTE, PLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1669916268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST KIDNEY INSTITUTE, PLC

Provider Business Mailing Address
First Line	:	2149 E WARNER RD
Second Line	:	STE 102
City	:	TEMPE
State	:	AZ
Zip	:	85284-3494
Country	:	US
Telephone Number	:	480-610-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2538 E UNIVERSITY DR
Second Line	:	STE 110
City	:	PHOENIX
State	:	AZ
Zip	:	85034-6917
Country	:	US
Telephone Number	:	480-969-8714
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF OPERATIONS
Name	:	PRADEEP MEHRA
Credential	:	MD
Telephone Number	:	480-610-6100

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	12/15/2016

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