Healthcare Provider Details

I. General information

NPI: 1104844562
Provider Name (Legal Business Name): NORTH BEACH DIALYSIS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 NW 13TH AVENUE
MIAMI FL
33169
US

IV. Provider business mailing address

1000 PARK CENTRE BLVD STE 134
MIAMI FL
33169-5373
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-7222
  • Fax: 305-653-0023
Mailing address:
  • Phone: 305-651-5762
  • Fax: 305-651-2961

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: STEVEN JEGER
Title or Position: VP
Credential:
Phone: 305-651-3261