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General NPI Number Information
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NPI Number | 1366857070
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Entity Type | Organization
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Legal Business Name | TOTAL KIDNEY OVERSIGHT PA
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 9400 GLADIOLUS DR
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City | FORT MYERS
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State | FL
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Zip | 33908-6699
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Country | US
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Telephone | 239-999-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 9400 GLADIOLUS DR
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City | FORT MYERS
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State | FL
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Zip | 33908-6699
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MS. LAUREEN MARINO
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Credential | MBA
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Telephone | 239-513-1002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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