MEDICARE: KIDNEY CARE CENTER,P.L.L.C.

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	174400000X	Specialist
2	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1871503268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY CARE CENTER,P.L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 343369
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38184-3369
Country	:	US
Telephone Number	:	901-684-3955
Fax Number	:	901-684-3956

Provider Business Practice Location Address
First Line	:	6005 PARK AVE STE 524B
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5215
Country	:	US
Telephone Number	:	901-684-3955
Fax Number	:	901-684-3956

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAMEEZ U. DIN
Credential	:	M.D.
Telephone Number	:	901-684-3955

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	10/21/2021

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