Basic Information
| Provider Information | |||||||||
| NPI: | 1669916268 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST KIDNEY INSTITUTE, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2149 E WARNER RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852843494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806106100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2538 E UNIVERSITY DR | ||||||||
| Address2: | STE 110 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850346917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809698714 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2016 | ||||||||
| LastUpdateDate: | 12/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | MEHRA | ||||||||
| AuthorizedOfficialFirstName: | PRADEEP | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4806106100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.