MEDICARE: HALLANDALE ARTIFICIAL KIDNEY 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V1S	OTHER	FL	BC/BS PROVIDER NO

General Provider Information

NPI Number	:	1699755355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLANDALE ARTIFICIAL KIDNEY CENTER, INC.

Provider Business Mailing Address
First Line	:	7061 CYPRESS RD
Second Line	:	SUITE 104
City	:	PLANTATION
State	:	FL
Zip	:	33317-2243
Country	:	US
Telephone Number	:	954-474-7701
Fax Number	:	954-474-7702

Provider Business Practice Location Address
First Line	:	2655 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4840
Country	:	US
Telephone Number	:	954-925-9909
Fax Number	:	954-927-5852

Authorized Official
Title or Position	:	DIRECTOR/VICE PRESIDENT
Name	:	MS. VICKI L BURRIER
Credential	:	RN, MBA
Telephone Number	:	954-474-7702

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	08/22/2020

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