Healthcare Provider Details

I. General information

NPI: 1528290590
Provider Name (Legal Business Name): INTERNATIONAL DIALYSIS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 HAMLIN ST NE
WASHINGTON DC
20018-1838
US

IV. Provider business mailing address

7061 CYPRESS RD SUITE 104
PLANTATION FL
33317-2243
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-7701
  • Fax: 954-474-7702
Mailing address:
  • Phone: 954-474-7701
  • Fax: 954-474-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberPENDING
License Number StateDC

VIII. Authorized Official

Name: MS. VICKI L BURRIER
Title or Position: PRESIDENT
Credential: R.N.
Phone: 954-474-7701