MEDICARE: SOUTHEAST IOWA KIDNEY CARE, HYPERTENSION AND MEDICINE CLINIC, 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	207RN0300X	Nephrology Physician	33195	IA

General Provider Information

NPI Number	:	1780025213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST IOWA KIDNEY CARE, HYPERTENSION AND MEDICINE CLINIC, LLC

Provider Business Mailing Address
First Line	:	641 PENNSYLVANIA AVE
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-2116
Country	:	US
Telephone Number	:	641-682-4557
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 PENNSYLVANIA AVE
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-2116
Country	:	US
Telephone Number	:	641-682-4557
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JASHIM UDDIN AHMED
Credential	:	M.D.
Telephone Number	:	641-682-4557

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	07/23/2013

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