1780684795 NPI number — NATIONAL KIDNEY PARTNERS, LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780684795 NPI number — NATIONAL KIDNEY PARTNERS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL KIDNEY PARTNERS, LLP
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:
JACKSONVILLE KIDNEY CENTER
Provider Other Organization Name Type Code:
3
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:
1780684795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14134 NEPHRON LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-266-1403
Provider Business Mailing Address Fax Number:
727-497-6784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14134 NEPHRON LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34667-6504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-863-5418
Provider Business Practice Location Address Fax Number:
727-869-8626
Provider Enumeration Date:
08/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
CREDENTIALING AND COMPLIANCE MGR
Authorized Official Telephone Number:
727-863-5418

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  ME0031702 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24654 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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