Basic Information
| Provider Information | |||||||||
| NPI: | 1033483052 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAGIC VALLEY KIDNEY INSTITUTE LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4908 | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832054908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082361600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 N HAVEN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833015788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087330422 | ||||||||
| FaxNumber: | 2087330412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2012 | ||||||||
| LastUpdateDate: | 12/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | RASHID | ||||||||
| AuthorizedOfficialFirstName: | HAROON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2013412217 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.