Provider Demographics
NPI:1780684795
Name:NATIONAL KIDNEY PARTNERS, LLP
Entity Type:Organization
Organization Name:NATIONAL KIDNEY PARTNERS, LLP
Other - Org Name:JACKSONVILLE KIDNEY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING AND COMPLIANCE MGR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-863-5418
Mailing Address - Street 1:14134 NEPHRON LANE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-266-1403
Mailing Address - Fax:727-497-6784
Practice Address - Street 1:14134 NEPHRON LN
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6504
Practice Address - Country:US
Practice Address - Phone:727-863-5418
Practice Address - Fax:727-869-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24654OtherBLUE CROSS BLUE SHIELD