Provo Kidney Care LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

001 Issued in UT

Legal business name

PROVO KIDNEY CARE LLC

Practice address

920 Winter St
Waltham, MA 02451-1521

Phone

(480) 639-7186

Fax

(602) 798-8267

NPI assigned

Jul 27, 2016

Organization subpart

No

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

Authorized official

Name

Pamela VP

Title

Vice President

Phone

(480) 639-7186

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469577600000",
    "number": "1972056893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 WINTER ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511521",
            "telephone_number": "480-639-7186",
            "fax_number": "602-798-8267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 WINTER ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511521",
            "telephone_number": "480-639-7186",
            "fax_number": "602-798-8267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVO KIDNEY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-27",
        "last_updated": "2016-07-27",
        "status": "A",
        "authorized_official_last_name": "VP",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "480-639-7186"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "UT",
            "license": "001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Prime
• Doris C Prince, P.T.
• Private Health Hub LLC
• Pro Sports Therapy, Inc.
• Nicole Provencher, LMHC
• Aimee Jeanne Ptak, D.P.T.
• Jason Pugatch, LICSW
• Pure Motion PT
• Putnoi Eye Care, P.C.
• Donald William Putnoi, M.D.

• Nephrology Physician in Waltham, MA
• Providers in Waltham, MA by specialty
• Nephrology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; 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.