1699755355 NPI number — HALLANDALE ARTIFICIAL KIDNEY CENTER, 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 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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