Provider Demographics
NPI:1629491501
Name:NXSTAGE ORLANDO SOUTH, LLC
Entity Type:Organization
Organization Name:NXSTAGE ORLANDO SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-530-4006
Mailing Address - Street 1:350 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1748
Mailing Address - Country:US
Mailing Address - Phone:978-530-4006
Mailing Address - Fax:
Practice Address - Street 1:14522 LANDSTAR BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-6450
Practice Address - Country:US
Practice Address - Phone:978-530-4006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NXSTAGE KIDNEY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-28
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment