Provider Demographics
NPI:1316046600
Name:UPPER VALLEY KIDNEY CLINIC LLC
Entity type:Organization
Organization Name:UPPER VALLEY KIDNEY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAYED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:937-335-9633
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-0734
Mailing Address - Country:US
Mailing Address - Phone:937-335-9633
Mailing Address - Fax:937-335-9464
Practice Address - Street 1:3130 N COUNTY ROAD 25A
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-335-9633
Practice Address - Fax:937-335-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080974207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHUP9356441Medicare ID - Type Unspecified