Provider Demographics
NPI:1790009165
Name:RENAL ACCESS OF CENTRAL FLORIDA LLC
Entity Type:Organization
Organization Name:RENAL ACCESS OF CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:AYCRIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-894-4693
Mailing Address - Street 1:807 S ORLANDO AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4870
Mailing Address - Country:US
Mailing Address - Phone:407-894-4693
Mailing Address - Fax:407-539-0469
Practice Address - Street 1:337 S NORTHLAKE BLVD
Practice Address - Street 2:SUITE 1002
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5264
Practice Address - Country:US
Practice Address - Phone:407-894-4693
Practice Address - Fax:407-539-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty