Provider Demographics
NPI:1710928924
Name:CENTRAL FLORIDA KIDNEY CENTERS INC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA KIDNEY CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-843-6110
Mailing Address - Street 1:203 ERNESTINE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3621
Mailing Address - Country:US
Mailing Address - Phone:407-843-6110
Mailing Address - Fax:407-425-1526
Practice Address - Street 1:203 ERNESTINE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3621
Practice Address - Country:US
Practice Address - Phone:407-843-6110
Practice Address - Fax:407-425-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4477Medicare ID - Type UnspecifiedCKD CLINIC