1235173006 NPI number — DIALYSIS SER CENTRAL FLORIDA LLC

Table of content: (NPI 1235173006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235173006 NPI number — DIALYSIS SER CENTRAL FLORIDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIALYSIS SER CENTRAL FLORIDA LLC
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:
1235173006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 UNION STREET
Provider Second Line Business Mailing Address:
SUITE 1800
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-467-0134
Provider Business Mailing Address Fax Number:
615-234-3504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 EXECUTIVE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APOPKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-389-8980
Provider Business Practice Location Address Fax Number:
407-389-8984
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUELL
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER MANAGER
Authorized Official Telephone Number:
407-894-4693

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: 301411 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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