Provider Demographics
NPI:1457574808
Name:SOUTH FLORIDA NEPHROLOGY CONSULTANTS PL
Entity Type:Organization
Organization Name:SOUTH FLORIDA NEPHROLOGY CONSULTANTS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALLSHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:954-986-9008
Mailing Address - Street 1:1150 N 35TH AVE
Mailing Address - Street 2:SUITE 465
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5424
Mailing Address - Country:US
Mailing Address - Phone:954-986-9008
Mailing Address - Fax:954-986-6646
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 465
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-986-9008
Practice Address - Fax:954-986-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278582000Medicaid