Organization Name: | MAQUOKETA KIDNEY CENTER, LLC |
NPI Number: | 1265768451 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAJESH ALLA (MEDICAL DIRECTOR) |
Mailing Address: | 700 W Grove St Maquoketa |
State: | IA US |
Postal Code: | 520602163 |
Phone Number: | 5636529674 |
Fax Number: | 5636529679 |
NPI Enumeration Date: | 10/23/2009 |
NPI Last Update Date: | 08/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |