1861688004 NPI number — KISSIMMEE NEPHROLOGY & HYPERTENSION, PA

Table of content: (NPI 1861688004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861688004 NPI number — KISSIMMEE NEPHROLOGY & HYPERTENSION, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KISSIMMEE NEPHROLOGY & HYPERTENSION, PA
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:
1861688004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2220 E IRLO BRONSON HWY
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34744-5312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-847-0019
Provider Business Mailing Address Fax Number:
407-518-0119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2220 E IRLO BRONSON HWY
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34744-5312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-847-0019
Provider Business Practice Location Address Fax Number:
407-518-0119
Provider Enumeration Date:
09/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZAMAN
Authorized Official First Name:
RIZWAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
407-830-5080

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , 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: 1003858275 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1386747798 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 44193Z . This is a "INDIVIDUAL MC PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AC951Z . This is a "INDIVIDUAL MC PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com