Healthcare Provider Details

I. General information

NPI: 1215917802
Provider Name (Legal Business Name): SILVER SPRING ARTIFICIAL KIDNEY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST SUITE 238
SILVER SPRING MD
20910-3806
US

IV. Provider business mailing address

7061 CYPRESS RD SUITE 104
PLANTATION FL
33317-2243
US

V. Phone/Fax

Practice location:
  • Phone: 301-563-6808
  • Fax: 301-563-6865
Mailing address:
  • Phone: 954-474-7701
  • Fax: 954-474-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberE2596
License Number StateMD

VIII. Authorized Official

Name: MS. VICKI L BURRIER
Title or Position: DIRECTOR/VICE-PRESIDENT
Credential: RN, MBA
Phone: 954-474-7701