The Kidney Center of South Philadelphia LLC

Primary specialty

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

Legal business name

THE KIDNEY CENTER OF SOUTH PHILADELPHIA LLC

Practice address

1930 S Broad St
Unit 7
Philadelphia, PA 19145-2328

Phone

(215) 463-3120

Fax

(215) 463-3107

NPI assigned

Feb 17, 2015

Last updated

Mar 17, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shari K Cousins

Title

Sr. VP of Clinical & Regulatory

Phone

(978) 922-3080

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584403200000",
    "number": "1982095626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 S BROAD ST",
            "address_2": "UNIT 7",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452328",
            "telephone_number": "215-463-3120",
            "fax_number": "215-463-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 S BROAD ST",
            "address_2": "UNIT 7",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452328",
            "telephone_number": "215-463-3120",
            "fax_number": "215-463-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KIDNEY CENTER OF SOUTH PHILADELPHIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-17",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A",
        "authorized_official_last_name": "COUSINS",
        "authorized_official_first_name": "SHARI",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SR. VP OF CLINICAL & REGULATORY",
        "authorized_official_telephone_number": "978-922-3080"
    },
    "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": "1030464270001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.