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General NPI Number Information
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NPI Number | 1346358538
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Entity Type | Organization
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Legal Business Name | DIALYSIS & KIDNEY CENTER OF NORTH BREVARD INC
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 830 CENTURY MEDICAL DR SUITE C
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City | TITUSVILLE
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State | FL
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Zip | 32796-2149
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Country | US
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Telephone | 321-269-6270
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Fax | 321-383-1625
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Provider Business Mailing Address
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Address Line | PO BOX 1067
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City | MIMS
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State | FL
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Zip | 32754-1067
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Country | US
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Telephone | 321-269-6270
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Fax | 321-383-1625
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JEANETTE P DEE
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Credential | RN
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Telephone | 321-269-6270
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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 | 05 0904
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License Number State | FL
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