Provider Demographics
NPI:1508138769
Name:DAVITA MEDICAL FLORIDA, INC.
Entity Type:Organization
Organization Name:DAVITA MEDICAL FLORIDA, INC.
Other - Org Name:DAVITA MEDICAL GROUP, PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-973-0777
Mailing Address - Street 1:10051 5TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2299
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-828-2321
Practice Address - Street 1:4757 US HIGHWAY 19 STE A
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4945
Practice Address - Country:US
Practice Address - Phone:727-849-9373
Practice Address - Fax:727-815-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FL186033336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133637OtherPK
FL4399230001Medicare NSC