1528290590 NPI number — INTERNATIONAL DIALYSIS CENTER, LLC

Table of content: (NPI 1528290590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528290590 NPI number — INTERNATIONAL DIALYSIS CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNATIONAL DIALYSIS CENTER, 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:
1528290590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2009
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:
1730 HAMLIN ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20018-1838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-474-7701
Provider Business Practice Location Address Fax Number:
954-474-7702
Provider Enumeration Date:
08/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BURRIER
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-474-7701

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  PENDING , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com