Provider Demographics
NPI:1871503268
Name:KIDNEY CARE CENTER,P.L.L.C.
Entity type:Organization
Organization Name:KIDNEY CARE CENTER,P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMEEZ
Authorized Official - Middle Name:U
Authorized Official - Last Name:DIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-684-3955
Mailing Address - Street 1:PO BOX 343369
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38184-3369
Mailing Address - Country:US
Mailing Address - Phone:901-684-3955
Mailing Address - Fax:901-684-3956
Practice Address - Street 1:6005 PARK AVE STE 524B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5215
Practice Address - Country:US
Practice Address - Phone:901-684-3955
Practice Address - Fax:901-684-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734913Medicare PIN