Organization
LEWIS-CLARK KIDNEY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA ANNE BRADY (CHIEF NURSING OFFICER)
(208) 371-7878
Entity
Organization
Contact information
Practice address
2116 12TH AVE, LEWISTON, ID 83501-3502
(208) 743-0662
(208) 743-0677
Mailing address
2116 12TH AVE, LEWISTON, ID 83501-3502
(208) 743-0662
(208) 743-0677
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457749475
—
ID
Enumeration date
12/29/2014
Last updated
01/10/2023
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