Provider Demographics
NPI:1629207873
Name:DIALYSIS CENTER OF NORTH BREVARD, LLC
Entity Type:Organization
Organization Name:DIALYSIS CENTER OF NORTH BREVARD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-269-6270
Mailing Address - Street 1:830 CENTURY MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2149
Mailing Address - Country:US
Mailing Address - Phone:321-269-6270
Mailing Address - Fax:
Practice Address - Street 1:830 CENTURY MEDICAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2149
Practice Address - Country:US
Practice Address - Phone:321-269-6270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH BREVARD MEDICAL SUPPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-09
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06643AOtherBCBSFL