Provider Demographics
NPI:1902837123
Name:GULF COAST KIDNEY CENTER INC
Entity Type:Organization
Organization Name:GULF COAST KIDNEY CENTER INC
Other - Org Name:PHYSICIANS DIALYSIS HUDSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-651-3261
Mailing Address - Street 1:19559 N E 10 AVENUE
Mailing Address - Street 2:
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3501
Mailing Address - Country:US
Mailing Address - Phone:305-651-3261
Mailing Address - Fax:305-651-2961
Practice Address - Street 1:14153 YOSEMITE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-8060
Practice Address - Country:US
Practice Address - Phone:727-862-0603
Practice Address - Fax:727-862-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL209147001Medicaid
FL102695Medicare Oscar/Certification