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General NPI Number Information
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NPI Number | 1144653270
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Entity Type | Organization
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Legal Business Name | NXSTAGE JACKSONVILLE, LLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 2777 UNIVERSITY BLVD W SUITE 39
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2176
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Country | US
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Telephone | 678-333-4944
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Fax |
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Provider Business Mailing Address
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Address Line | 3430 RIVERS CALL BLVD
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City | ATLANTA
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State | GA
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Zip | 30339-5611
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Country | US
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Telephone | 678-333-4944
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Fax |
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Authorized Official
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Title or Position | PRESIDENT NXSTAGE KIDNEY CARE INC.
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Name | MR. ROBERT BROWN
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Credential |
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Telephone | 978-687-4703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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