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NPI Code Detail

MEDICARE: ALL ACCESS MOBILE HEMODIALYSIS,LLC

MEDICARE: ALL ACCESS MOBILE HEMODIALYSIS,LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC1600XContinuing Education/Staff Development Registered Nurse
2163WR0400XRehabilitation Registered Nurse
32472R0900XRenal Dialysis Technician
4163W00000XRegistered NurseRN1612642FL
5163WA2000XAdministrator Registered NurseRN1612642FL
6163WC1600XContinuing Education/Staff Development Registered NurseRN1612642FL
7163WH0200XHome Health Registered NurseRN1612642FL
8163WH1000XHospice Registered NurseRN1612642FL
9163WP0000XPain Management Registered NurseRN1612642FL
10163WN1003XNutrition Support Registered NurseRN1612642FL
11163WH0500XHemodialysis Registered NurseRN1612642FL

General Provider Information

NPI Number : 1063763159
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALL ACCESS MOBILE HEMODIALYSIS,LLC
Provider Business Mailing Address
First Line : PO BOX 11434
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32120-1434
Country : US
Telephone Number : 800-381-7639
Fax Number : 800-381-7639
Provider Business Practice Location Address
First Line : 100 OPAL HILL CIR
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32124-2018
Country : US
Telephone Number : 800-381-7639
Fax Number : 800-381-7639
Authorized Official
Title or Position : CEO
Name : MR. ROBERTO DONALD BARRAGAN III
Credential :
Telephone Number : 800-381-7639
Provider Enumeration Date : 09/28/2012
Last Update Date : 01/01/2013

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Directions to “ALL ACCESS MOBILE HEMODIALYSIS,LLC ” Practice Location

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