Healthcare Provider Details

I. General information

NPI: 1407891898
Provider Name (Legal Business Name): OCALA KIDNEY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 SE 3RD CT
OCALA FL
34471-0421
US

IV. Provider business mailing address

2980 SE 3RD CT
OCALA FL
34471-0421
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-4231
  • Fax: 352-622-0513
Mailing address:
  • Phone: 352-622-4231
  • Fax: 352-622-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ZINA G PADGETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 352-622-4231