Provider Demographics
NPI:1043306822
Name:UNIVERSAL KIDNEY CENTER OF MARGATE CORAL SPRINGS LLC
Entity Type:Organization
Organization Name:UNIVERSAL KIDNEY CENTER OF MARGATE CORAL SPRINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMO
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:BARTOLOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-770-6540
Mailing Address - Street 1:2004 NE 49TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4524
Mailing Address - Country:US
Mailing Address - Phone:954-958-9300
Mailing Address - Fax:954-318-4086
Practice Address - Street 1:2800 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5728
Practice Address - Country:US
Practice Address - Phone:954-770-6540
Practice Address - Fax:954-318-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102860Medicare PIN