MEDICARE: BRADENTON DIALYSIS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174646558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADENTON DIALYSIS CENTER LLC

Provider Business Mailing Address
First Line	:	5837 21ST AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5641
Country	:	US
Telephone Number	:	941-792-7800
Fax Number	:	941-792-7822

Provider Business Practice Location Address
First Line	:	5837 21ST AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5641
Country	:	US
Telephone Number	:	941-792-7800
Fax Number	:	941-792-7822

Authorized Official
Title or Position	:	CHIEF NURSING OFFICER
Name	:	SARA ANNE BRADY
Credential	:
Telephone Number	:	208-371-7878

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	01/10/2023

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