Provider Demographics
NPI:1558999490
Name:CENTRAL DIALYSIS LLC
Entity Type:Organization
Organization Name:CENTRAL DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AWWAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-322-0245
Mailing Address - Street 1:5631 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1703
Mailing Address - Country:US
Mailing Address - Phone:727-322-0245
Mailing Address - Fax:727-323-0994
Practice Address - Street 1:5631 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1703
Practice Address - Country:US
Practice Address - Phone:727-322-0245
Practice Address - Fax:727-323-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment