Provider Demographics
NPI:1700027604
Name:KIDNEY KARE OUTPATIENT SERVICES
Entity Type:Organization
Organization Name:KIDNEY KARE OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-764-7695
Mailing Address - Street 1:326 E DANIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-3028
Mailing Address - Country:US
Mailing Address - Phone:954-764-7695
Mailing Address - Fax:954-764-7697
Practice Address - Street 1:326 E DANIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-3028
Practice Address - Country:US
Practice Address - Phone:954-764-7695
Practice Address - Fax:954-764-7697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment