Healthcare Provider Details

I. General information

NPI: 1245410091
Provider Name (Legal Business Name): SOUTH CENTRAL FLORIDA DIALYSIS PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-1430
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400 L&C
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 407-498-0018
  • Fax: 407-498-0881
Mailing address:
  • Phone: 615-320-4218
  • Fax: 303-209-7825

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: JAMES K HILGER
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-382-1919