1699755355 NPI number — HALLANDALE ARTIFICIAL KIDNEY CENTER, INC.

Table of content: (NPI 1699755355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699755355 NPI number — HALLANDALE ARTIFICIAL KIDNEY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALLANDALE ARTIFICIAL KIDNEY CENTER, 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:
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:
1699755355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7061 CYPRESS RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33317-2243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-474-7701
Provider Business Mailing Address Fax Number:
954-474-7702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2655 HOLLYWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33020-4840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-925-9909
Provider Business Practice Location Address Fax Number:
954-927-5852
Provider Enumeration Date:
01/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURRIER
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR/VICE PRESIDENT
Authorized Official Telephone Number:
954-474-7702

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: V1S . This is a "BC/BS PROVIDER NO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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