ESTRELLA MOUNTAIN DIALYSIS LLC


Address: 9250 W Thomas Rd, Suite 120, Phoenix, AZ 85037-3382
Phone: 6237727363

ESTRELLA MOUNTAIN DIALYSIS LLC (NPI# 1063767739) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1063767739
Entity Type Organization
Organization Name ESTRELLA MOUNTAIN DIALYSIS LLC
Practice Address 9250 W Thomas Rd
Suite 120
Phoenix
AZ 85037-3382
Practice Telephone 6237727363
Practice Fax Number 6237727364
Mailing Telephone 6237727363
Mailing Fax Number 6237727364
Enumeration Date 2012-07-19
Last Update Date 2020-03-11
Authorized Official Name SHARI K COUSINS (SR. VP OF CLINICAL & REGULATORY)
Authorized Official Telephone 9789223080
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QE0700X Clinic/Center
Specialization: End-Stage Renal Disease (ESRD) Treatment
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
AZ 802100 05

Office Location

Street Address 9250 W THOMAS RD
SUITE 120
City PHOENIX
State AZ
Zip Code 85037-3382

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NPI Name Taxonomy Address Enumeration
1124009352 Jon A King Surgery 9250 W Thomas Rd, Ste 250, Phoenix, AZ 85037-3382 2005-11-05
1114431905 Travis Nichols Psychologist 9250 W Thomas Rd, Phoenix, AZ 85037-3382 2017-12-01
1033623285 Jordan Butay Physical Therapist 9250 W Thomas Rd, Phoenix, AZ 85037-3382 2017-11-27
1821471913 Arizona Surgical Specialists Center, LLC Clinic/Center 9250 W Thomas Rd, Suite 220, Phoenix, AZ 85037-3382 2015-07-07
1477956621 The Pain Center of Arizona, PC Durable Medical Equipment & Medical Supplies 9250 W Thomas Rd, Suite 200, Phoenix, AZ 85037-3382 2014-10-02
1114333432 The Pain Center of Arizona, PC Non-Pharmacy Dispensing Site 9250 W Thomas Rd, Suite 200, Phoenix, AZ 85037-3382 2014-07-08
1891031019 Manjit K Wright Physician Assistant 9250 W Thomas Rd, Suite 100, Phoenix, AZ 85037-3382 2012-12-15
1477824894 Alice Mustapha Amara Nurse Practitioner 9250 W Thomas Rd, Suite 200, Phoenix, AZ 85037-3382 2012-01-17
1770787863 David Wayne Smith Surgery 9250 W Thomas Rd, Suite 250, Phoenix, AZ 85037-3382 2007-06-12
1497959589 Ravia Bokhari Surgery 9250 W Thomas Rd, Ste 250, Phoenix, AZ 85037-3382 2007-06-12
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Taxonomy Information

Taxonomy Code 261QE0700X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization End-Stage Renal Disease (ESRD) Treatment

Taxonomy Definition

Definition to come...

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1932688256 Southwest Kidney Davita Dialysis Partners LLC Clinic/Center 926 E Mcdowell Rd Ste 100, Phoenix, AZ 85006-2503 2018-08-08
1982152484 Bio-medical Applications of Arizona, LLC Clinic/Center 4901 W Mcdowell Rd Ste 120, Phoenix, AZ 85035-4160 2016-09-14
1528442779 Bio-medical Applications of Arizona, LLC Clinic/Center 16605 N 28th Ave Ste 100, Phoenix, AZ 85053-7551 2015-07-17
1295070761 Calaveras Dialysis LLC Clinic/Center 5115 E Thomas Rd, Ste 115, Phoenix, AZ 85018-7914 2012-12-10
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1770758526 Southwest Kidney Davita Dialysis Partners LLC Clinic/Center 4845 W Mcdowell Rd, Ste 10a, 20a, 30a, Phoenix, AZ 85035-4076 2008-04-23
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1477665289 Renal Dimensions, LLC Clinic/Center 15930 S 48th St, Suite 100, Phoenix, AZ 85048-0903 2006-08-31
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Competitor

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City PHOENIX
Zip Code 85037

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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