1578569109 NPI number — CENTRAL FLORIDA KIDNEY CENTERS INC

Table of content: (NPI 1578569109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578569109 NPI number — CENTRAL FLORIDA KIDNEY CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL FLORIDA KIDNEY CENTERS 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:
NORTH MELBOURNE DIALYSIS
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:
1578569109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 ERNESTINE STREET
Provider Second Line Business Mailing Address:
CENTRAL FLORIDA KIDNEY CENTERS, INC.
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32801-3621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-843-6110
Provider Business Mailing Address Fax Number:
407-425-1526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 SUNTREE PL
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940-7605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-253-9033
Provider Business Practice Location Address Fax Number:
321-253-8632
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BUHRING
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
407-843-6110

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: 212490400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003586800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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