MEDICARE: BOCA/DELRAY RENAL ASSOCIATES, INC

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
2	V7V	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1528047909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOCA/DELRAY RENAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	1905 CLINT MOORE RD
Second Line	:	SUITE 306
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2658
Country	:	US
Telephone Number	:	561-988-7100
Fax Number	:	561-988-6120

Provider Business Practice Location Address
First Line	:	1905 CLINT MOORE RD
Second Line	:	SUITE 306
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2658
Country	:	US
Telephone Number	:	561-988-7100
Fax Number	:	561-988-6120

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	FRANCES L KRAUSE
Credential	:
Telephone Number	:	561-988-7100

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	04/01/2009

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