Healthcare Provider Details

I. General information

NPI: 1326028002
Provider Name (Legal Business Name): NEW SMYRNA BEACH ARTIFICIAL KIDNEY, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 STATE ROAD 44
NEW SMYRNA BEACH FL
32168-7271
US

IV. Provider business mailing address

424 CHURCH ST SUITE 1900
NASHVILLE TN
37219-2301
US

V. Phone/Fax

Practice location:
  • Phone: 386-409-8855
  • Fax: 386-409-8755
Mailing address:
  • Phone: 615-234-1160
  • Fax: 615-234-2440

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: THOMAS L. WEINBERG
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 214-736-2700