Organization
LEWIS CLARK KIDNEY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJITH J KUMAR M.D. (MEDICAL DIRECTOR)
(208) 743-9986
Entity
Organization
Contact information
Practice address
222 SOUTHWAY AVE STE A, LEWISTON, ID 83501-2703
(208) 743-9986
(208) 743-1318
Mailing address
1835 G ST, LEWISTON, ID 83501-2034
(208) 743-9986
(208) 743-1318
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
02/04/2014
Last updated
02/04/2014
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