Provider Demographics
NPI:1952307589
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 1:220 MEDPLEX PKWY NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2560
Practice Address - Country:US
Practice Address - Phone:321-722-2649
Practice Address - Fax:321-722-2716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL FLORIDA KIDNEY CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
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
FL100626200Medicaid
FL200512301Medicaid