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General NPI Number Information
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NPI Number | 1215959184
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Entity Type | Organization
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Legal Business Name | UNIVERSAL KIDNEY CENTER OF PEMBROKE PINES-MIRAMAR LLC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 18004 NW 6TH ST STE 101
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2823
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Country | US
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Telephone | 954-433-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 18004 NW 6TH ST STE 101
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2823
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Country | US
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Telephone | 954-433-9400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ELMO ANGELO V. BARTOLOME
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Credential |
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Telephone | 954-770-6540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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