Maquoketa Kidney Center, LLC

Primary specialty

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

Legal business name

MAQUOKETA KIDNEY CENTER, LLC

Practice address

700 W Grove St
Maquoketa, IA 52060-2163

Phone

(563) 652-9674

Fax

(563) 652-9679

NPI assigned

Oct 23, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Rajesh Alla, M.D.

Title

Medical Director

Phone

(309) 762-5570

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409270400000",
    "number": "1265768451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 JOHN DEERE RD",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656898",
            "telephone_number": "309-762-5570",
            "fax_number": "309-762-5297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W GROVE ST",
            "city": "MAQUOKETA",
            "state": "IA",
            "postal_code": "520602163",
            "telephone_number": "563-652-9674",
            "fax_number": "563-652-9679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAQUOKETA KIDNEY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2014-08-29",
        "status": "A",
        "authorized_official_last_name": "ALLA",
        "authorized_official_first_name": "RAJESH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "309-762-5570",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265768451",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IA / WELLMARK",
            "identifier": "62543",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jody L Livesay, ARNP
• Bobbie Lona Mallari, ARNP AGPCNP
• Maquoketa Care Center, Inc
• Maquoketa Community School District
• Maquoketa Family Clinic
• Maquoketa Opco LLC
• Maquoketa Pharmacy Inc
• Maquoketa Pharmacy Inc
• Marcia Gansen Martin
• Nathan McCarty

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maquoketa, IA
• Providers in Maquoketa, IA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; 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.