Provider Demographics
NPI:1407891898
Name:OCALA KIDNEY GROUP INC
Entity Type:Organization
Organization Name:OCALA KIDNEY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-622-4231
Mailing Address - Street 1:2980 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0421
Mailing Address - Country:US
Mailing Address - Phone:352-622-4231
Mailing Address - Fax:352-622-0513
Practice Address - Street 1:2980 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0421
Practice Address - Country:US
Practice Address - Phone:352-622-4231
Practice Address - Fax:352-622-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060948002Medicaid
FL97627OtherBLUE SHIELD FLORIDA PIN
FLCD4677OtherRAILROAD MEDICARE PIN
FL060948000Medicaid
FL060948001Medicaid
FL060948003Medicaid