Provider Demographics
NPI:1962435644
Name:MIDWEST KIDNEY CARE, LLC
Entity type:Organization
Organization Name:MIDWEST KIDNEY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.P. OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KURZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-762-2020
Mailing Address - Street 1:335 MAHN CT
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2155
Mailing Address - Country:US
Mailing Address - Phone:414-762-2020
Mailing Address - Fax:414-762-2024
Practice Address - Street 1:2050 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-7848
Practice Address - Country:US
Practice Address - Phone:262-306-2700
Practice Address - Fax:262-306-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42058000OtherMEDICAID PROVIDER NUMBER
WI42058000Medicaid
WI5222544OtherMEDICARE PROVIDER NUMBER
WI=========OtherTAX ID NUMBER
WI42058000OtherMEDICAID PROVIDER NUMBER