MEDICARE: PEMBROKE PINES 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	V3Y	OTHER	FL	BC/BS PROVIDER NO

General Provider Information

NPI Number	:	1871573451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEMBROKE PINES 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	:	12145 PEMBROKE RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-1727
Country	:	US
Telephone Number	:	954-435-2553
Fax Number	:	954-435-3361

Authorized Official
Title or Position	:	DIRECTOR/VICE-PRESIDENT
Name	:	MS. VICKI L BURRIER
Credential	:	RN, MBA
Telephone Number	:	954-474-7701

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	10/20/2009

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