Provider Demographics
NPI:1386892610
Name:VALLEY KIDNEY CORP.
Entity type:Organization
Organization Name:VALLEY KIDNEY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MASHOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:QADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-584-3491
Mailing Address - Street 1:1600 W. CHANDLER BLVD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6100
Mailing Address - Country:US
Mailing Address - Phone:480-584-3491
Mailing Address - Fax:480-584-4693
Practice Address - Street 1:1600 W. CHANDLER BLVD.
Practice Address - Street 2:SUITE #110
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6100
Practice Address - Country:US
Practice Address - Phone:480-584-3491
Practice Address - Fax:480-584-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ214680Medicaid
AZP00461797Medicare PIN
AZ214680Medicaid
Z115654Medicare PIN