Arizona Kidney Care LLC

Organization Active NPI Nephrology Physician · Kingman, AZ

NPI 1497231237 · NPPES record last updated Jul 21, 2018

Key facts

NPI
1497231237
Entity type
Organization (NPI type 2)
Primary specialty
Nephrology Physician 207RN0300X
License
49359 (AZ)
Legal business name
ARIZONA KIDNEY CARE LLC
Practice address
2901 N Stockton Hill Rd Ste B
Kingman, AZ 86401
Phone
(928) 718-0777
Fax
(928) 718-0877
NPI assigned
Jul 16, 2018
Organization subpart
No

Authorized official

Name
Sharmila Parvathaneni, M.D.
Title
Owner/Member Manager
Phone
(928) 718-0777

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AZ

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20180921003213 AZ Part B Supplier - Clinic/Group Practice 2466703970 Receives reassigned benefits from 4 practitioners
Practice locations: Kingman, AZ; Bullhead City, AZ

National Provider Directory

Locations

2901 N Stockton Hill Rd
Kingman, AZ 86401
Phone (520) 718-8881

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician
Group: 193400000X SINGLE SPECIALTY GROUP
207RN0300X 49359 AZ Yes

Addresses

Primary practice location

2901 N Stockton Hill Rd Ste B
Kingman, AZ 86401

Mailing address

PO Box 3837
Kingman, AZ 86402-3837
Phone (928) 718-0777

Other providers in Kingman, AZ

All providers in Kingman, AZ · Nephrology Physician in Arizona

Sources for this page

Verify at the official NPI Registry.