Organization
SOUTHWEST KIDNEY DIALYSIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE MAUVAIS (CFO)
(480) 610-6110
Entity
Organization
Contact information
Practice address
10238 E. HAMPTON AVENUE, SUITE 108, MESA, AZ 85209
(480) 610-6118
Mailing address
2149 E WARNER RD, SUITE 112, TEMPE, AZ 85284-3494
(480) 610-6100
(480) 610-6195
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
09/20/2007
Last updated
09/20/2007
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