Healthcare Provider Details

I. General information

NPI: 1336209568
Provider Name (Legal Business Name): DAVITA MEDICAL FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 W LUMSDEN RD
BRANDON FL
33511-8819
US

IV. Provider business mailing address

10051 5TH STREET NORTH
ST. PETERSBURG FL
33702-2299
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-7888
  • Fax: 813-661-0843
Mailing address:
  • Phone: 813-681-7888
  • Fax: 813-661-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH13061
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES HILGER
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-973-0777