1457992414 NPI number — CENTER FOR HOME DIALYSIS AT LAKEWOOD RANCH LLC

Table of content: KRYSTA WEISZ WHITE MOT, LOTR (NPI 1609358639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457992414 NPI number — CENTER FOR HOME DIALYSIS AT LAKEWOOD RANCH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR HOME DIALYSIS AT LAKEWOOD RANCH 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:
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:
1457992414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1685
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM HARBOR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34682-1685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1939 WORTH COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD RANCH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-215-0940
Provider Business Practice Location Address Fax Number:
727-287-6305
Provider Enumeration Date:
10/01/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ACHARYA
Authorized Official First Name:
MURALIDHAR
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
727-808-2227

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)





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