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General NPI Number Information
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NPI Number | 1528290590
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL DIALYSIS CENTER, LLC
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 1730 HAMLIN ST NE
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City | WASHINGTON
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State | DC
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Zip | 20018-1838
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Country | US
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Telephone | 954-474-7701
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Fax | 954-474-7702
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Provider Business Mailing Address
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Address Line | 7061 CYPRESS RD SUITE 104
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City | PLANTATION
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State | FL
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Zip | 33317-2243
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Country | US
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Telephone | 954-474-7701
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Fax | 954-474-7702
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. VICKI L BURRIER
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Credential | R.N.
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Telephone | 954-474-7701
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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 | PENDING
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License Number State | DC
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