1508233537 NPI number — DAVITA MEDICAL FLORIDA, INC.

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 1508233537 NPI number — DAVITA MEDICAL FLORIDA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVITA MEDICAL FLORIDA, INC.
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:
6
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:
1508233537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10051 5TH STREET N.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 MANATEE AVE W
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34205-4954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-847-7920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
EDGINGTON
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
727-286-4065

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  ME116650 , 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)





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