Provider Demographics
NPI:1114953882
Name:ADVANCED DIALYSIS INSTITUTE, INC
Entity Type:Organization
Organization Name:ADVANCED DIALYSIS INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRYAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-827-8399
Mailing Address - Street 1:7150 W 20TH AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5529
Mailing Address - Country:US
Mailing Address - Phone:305-827-8399
Mailing Address - Fax:305-827-1204
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5529
Practice Address - Country:US
Practice Address - Phone:305-827-8399
Practice Address - Fax:305-827-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL211029600Medicaid
FL211029600Medicaid