MODESTO KIDNEY CENTER INC. NPI 1003887712

NPI Information

MODESTO KIDNEY CENTER, INC. is an end-stage renal disease (esrd) treatment clinic center in Modesto, CA. MODESTO KIDNEY CENTER, INC. NPI is 1003887712. The provider is registered as an organization entity type.

The provider's business location address is:

305 E GRANGER AVE
MODESTO, CA
ZIP 95350-345
Phone: (209) 574-6800
Fax: (209) 574-6808

The provider's authorized official is Jerry Green .
The authorized official title is Secretary and has the following contact phone number (562) 495-8075.

The CLIA number assigned to this NPI record is 05D0912738 - end stage renal disease dialysis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/30/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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