Provider Demographics
NPI:1316367998
Name:SOUTH FLORIDA KIDNEY CARE LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA KIDNEY CARE LLC
Other - Org Name:COMPREHENSIVE KIDNEY CARE OF SOUTH FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-651-0795
Mailing Address - Street 1:3854 SHERIDAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3630
Mailing Address - Country:US
Mailing Address - Phone:954-966-3018
Mailing Address - Fax:954-966-5249
Practice Address - Street 1:3854 SHERIDAN ST STE A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3630
Practice Address - Country:US
Practice Address - Phone:954-966-3018
Practice Address - Fax:954-966-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012854700Medicaid