Provider Demographics
NPI:1538498134
Name:KND DEVELOPMENT 59, LLC
Entity Type:Organization
Organization Name:KND DEVELOPMENT 59, LLC
Other - Org Name:4640 KH BAY AREA TAMPA
Other - Org Type:Other Name
Authorized Official - Title/Position:DVP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7358
Mailing Address - Street 1:680 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2407
Mailing Address - Country:US
Mailing Address - Phone:502-596-7358
Mailing Address - Fax:833-501-9731
Practice Address - Street 1:4555 S MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2305
Practice Address - Country:US
Practice Address - Phone:813-839-6341
Practice Address - Fax:502-596-4150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINDREDN HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-10
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDL118AOtherMEDICARE