| Kidney Guardian | |
|
436 E Southern Ave Tempe AZ 85282-5216 | |
| (480) 297-7361 | |
| (602) 207-8899 |
| Full Name | Kidney Guardian |
|---|---|
| Speciality | Internal Medicine |
| Location | 436 E Southern Ave, Tempe, Arizona |
| Authorized Official Name and Position | Mhd Kussay Samkari (OWNER/PROVIDER) |
| Authorized Official Contact | 4808958734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidney Guardian Po Box 10741 Tempe AZ 85284-0013 Ph: (602) 741-5504 | Kidney Guardian 436 E Southern Ave Tempe AZ 85282-5216 Ph: (480) 297-7361 |
| NPI Number | 1013475326 |
|---|---|
| Provider Enumeration Date | 03/05/2019 |
| Last Update Date | 12/01/2021 |
| Certification Date | 11/19/2021 |
| Medicare PECOS PAC ID | 8628308186 |
|---|---|
| Medicare Enrollment ID | O20190925002955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013475326 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Secondary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | () | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | () | Primary |
| Provider Name | Mhd Kussay Alsamkari |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1336106186 PECOS PAC ID: 6406883172 Enrollment ID: I20050725000649 |
| Provider Name | Amy Jo Purvis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467708156 PECOS PAC ID: 5496992281 Enrollment ID: I20130515000434 |
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