1306811393 NPI number — RENAL CARE OF WHITE OAK, LLC

Table of content: (NPI 1306811393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306811393 NPI number — RENAL CARE OF WHITE OAK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAL CARE OF WHITE OAK, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306811393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 LINCOLN RD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33139-3020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-534-5102
Provider Business Mailing Address Fax Number:
305-673-1916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1303 LINCOLN WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WHITE OAK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15131-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-673-1191
Provider Business Practice Location Address Fax Number:
412-678-1746
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLOOD
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
305-534-5102

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1014279800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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