Provider Demographics
NPI:1033109152
Name:SARASOTA PHYSICIANS DIALYSIS CENTER INC.
Entity Type:Organization
Organization Name:SARASOTA PHYSICIANS DIALYSIS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAGIERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-917-6447
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-917-6447
Mailing Address - Fax:941-917-6448
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-6447
Practice Address - Fax:941-917-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102596Medicare ID - Type UnspecifiedFREESTANDING ESRD