Organization
SOUTHWEST KIDNEY DIALYSIS, LLC
Active
Other names
Southwest Kidney Dialysis - Estrella
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE R. MAUVAIS (CHEIF FINANCIAL OFFICER)
(480) 610-6110
Entity
Organization
Contact information
Practice address
8410 W THOMAS ROAD, BUILDING 1, SUITE 100, PHOENIX, AZ 85037-3494
(480) 610-6118
(480) 610-6195
Mailing address
2149 E WARNER RD, SUITE 101, TEMPE, AZ 85284-3494
(623) 247-0808
(623) 247-9235
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032612
MEDICARE
AZ
Enumeration date
07/31/2006
Last updated
07/26/2007
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