Modesto Kidney Center, Inc.

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

MODESTO KIDNEY CENTER, INC.

Practice address

305 E Granger Ave
Modesto, CA 95350-4345

Phone

(209) 574-6800

Fax

(209) 574-6808

NPI assigned

Jan 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jerry Green

Title

Secretary

Phone

(562) 495-8075

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003887712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WORLD TRADE CTR",
            "address_2": "2500",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908310002",
            "telephone_number": "562-495-8075",
            "fax_number": "562-495-8076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E GRANGER AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504345",
            "telephone_number": "209-574-6800",
            "fax_number": "209-574-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO KIDNEY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "562-495-8075",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CDC02783F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Modesto Eye Center Inc
• Modesto Fire Department
• Modesto Gastroenterology Medical Corporation
• Modesto Gospel Mission
• Modesto Hearing Aid Center
• Modesto Kidney Center, LLC
• Modesto Kidney Medical Group
• Modesto Mental Health Consultants Inc a Professional Medical Corp
• Modesto Mobility Center Inc.
• Modesto Natural Birth Place

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Modesto, CA
• Providers in Modesto, CA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.