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General NPI Number Information
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NPI Number | 1245720820
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Entity Type | Organization
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Legal Business Name | TOTAL RENAL LABORATORIES INC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 3000 DAVITA WAY
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City | DELAND
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State | FL
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Zip | 32724
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Country | US
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Telephone | 386-626-5700
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Fax | 386-626-5638
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Provider Business Mailing Address
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Address Line | PO BOX 100244
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City | ATLANTA
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State | GA
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Zip | 30384-0244
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Country | US
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Telephone | 386-626-5700
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Fax |
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Authorized Official
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Title or Position | VP - GENERAL MANAGER
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Name | KERI WAGNER
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Credential |
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Telephone | 386-626-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 800005025
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License Number State | FL
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