Healthcare Provider Details

I. General information

NPI: 1235173006
Provider Name (Legal Business Name): DIALYSIS SER CENTRAL FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 EXECUTIVE PARK
APOPKA FL
32703
US

IV. Provider business mailing address

511 UNION STREET SUITE 1800
NASHVILLE TN
37219
US

V. Phone/Fax

Practice location:
  • Phone: 407-389-8980
  • Fax: 407-389-8984
Mailing address:
  • Phone: 615-467-0134
  • Fax: 615-234-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TIMOTHY D YOUELL
Title or Position: OWNER MANAGER
Credential: MD
Phone: 407-894-4693