Provider Demographics
NPI:1285742262
Name:KIDNEY AND HYPERTENSION PLC
Entity type:Organization
Organization Name:KIDNEY AND HYPERTENSION PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:M
Authorized Official - Last Name:RABADI
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:701-775-5800
Mailing Address - Street 1:5750 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-7593
Mailing Address - Country:US
Mailing Address - Phone:701-775-5800
Mailing Address - Fax:701-775-5200
Practice Address - Street 1:5750 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-7593
Practice Address - Country:US
Practice Address - Phone:701-775-5800
Practice Address - Fax:701-775-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QM1300X
ND261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN71149Medicare PIN