Provider Demographics
NPI:1194178889
Name:RENVIVA DIALYSIS CENTER OF CLEARWATER
Entity Type:Organization
Organization Name:RENVIVA DIALYSIS CENTER OF CLEARWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRITZSCH
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:513-673-5245
Mailing Address - Street 1:213 PELICAN WAY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-8011
Mailing Address - Country:US
Mailing Address - Phone:513-673-5245
Mailing Address - Fax:866-352-4339
Practice Address - Street 1:401 CORBETT ST
Practice Address - Street 2:SUITE 250
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-7309
Practice Address - Country:US
Practice Address - Phone:513-673-5245
Practice Address - Fax:866-352-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment