MEDICARE: CENTRAL FLORIDA 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	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

General Provider Information

NPI Number	:	1891788550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FLORIDA KIDNEY CENTERS INC

Provider Business Mailing Address
First Line	:	203 ERNESTINE ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3621
Country	:	US
Telephone Number	:	407-843-6110
Fax Number	:	407-425-1526

Provider Business Practice Location Address
First Line	:	14522 LANDSTAR BLVD
Second Line	:	UNIT 108
City	:	ORLANDO
State	:	FL
Zip	:	32824-6450
Country	:	US
Telephone Number	:	407-843-6110
Fax Number	:	407-425-1526

Authorized Official
Title or Position	:	CEO
Name	:	AMY KOZSUCH
Credential	:
Telephone Number	:	407-843-6110

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	05/07/2025

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