MEDICARE: ATLANTIC KIDNEY CENTERS 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	207RN0300X	Nephrology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	209348	OTHER	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	V7Q	OTHER	BCBS OF FL

General Provider Information

NPI Number	:	1881675239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC KIDNEY CENTERS INC

Provider Business Mailing Address
First Line	:	4700 N CONGRESS AVE
Second Line	:	STE 104
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3282
Country	:	US
Telephone Number	:	561-845-2888
Fax Number	:	561-845-7282

Provider Business Practice Location Address
First Line	:	4700 N CONGRESS AVE
Second Line	:	STE 104
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3282
Country	:	US
Telephone Number	:	561-845-2888
Fax Number	:	561-845-7282

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MARIETTA HOLMES
Credential	:
Telephone Number	:	561-845-2888

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	08/22/2020

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Directions to “ATLANTIC KIDNEY CENTERS INC ” Practice Location

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