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General NPI Number Information
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NPI Number | 1447362835
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Entity Type | Organization
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Legal Business Name | UNIVERSAL KIDNEY CENTER INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 4875 NE 20TH TERRACE
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City | FL LAUDERDALE
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State | FL
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Zip | 33308-4515
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Country | US
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Telephone | 954-958-9300
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Fax | 954-318-4086
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Provider Business Mailing Address
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Address Line | 4875 NE 20TH TERRACE
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City | FL LAUDERDALE
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State | FL
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Zip | 33308-4515
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Country | US
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Telephone | 954-958-9300
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Fax | 954-318-4086
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Authorized Official
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Title or Position | CFO COO
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Name | MR. ELMO ANGELO V BARTOLOME
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Credential |
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Telephone | 954-958-9300
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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 | CLEA LIC # 800001259
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License Number State | FL
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