Organization
THE KIDNEY CENTER OF SOUTH PHILADELPHIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARI K COUSINS (SR. VP OF CLINICAL & REGULATORY)
(978) 922-3080
Entity
Organization
Contact information
Practice address
1930 S BROAD ST, UNIT 7, PHILADELPHIA, PA 19145-2328
(215) 463-3120
(215) 463-3107
Mailing address
1930 S BROAD ST, UNIT 7, PHILADELPHIA, PA 19145-2328
(215) 463-3120
(215) 463-3107
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
—
1030464270001
—
PA
Enumeration date
02/17/2015
Last updated
03/17/2020
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