MEDICARE: SYNERGY DIALYSIS CENTER, 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

General Provider Information

NPI Number	:	1548679111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY DIALYSIS CENTER, INC

Provider Business Mailing Address
First Line	:	1311 E ATLANTIC BLVD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6744
Country	:	US
Telephone Number	:	305-778-8277
Fax Number	:	888-349-8679

Provider Business Practice Location Address
First Line	:	1311 E ATLANTIC BLVD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6744
Country	:	US
Telephone Number	:	305-778-8277
Fax Number	:	888-349-8679

Authorized Official
Title or Position	:	MGRM
Name	:	MYRLENE BARRERA
Credential	:
Telephone Number	:	305-778-8277

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	08/08/2014

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