Provider Demographics
NPI:1245236876
Name:CENTRAL FLORIDA KIDNEY CENTERS INC
Entity type:Organization
Organization Name:CENTRAL FLORIDA KIDNEY CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZSUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-843-6110
Mailing Address - Street 1:203 ERNESTINE STREET
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 1:1400 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3145
Practice Address - Country:US
Practice Address - Phone:321-724-0431
Practice Address - Fax:321-728-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2025-05-07
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
FL200512300Medicaid
102517Medicare Oscar/Certification