Basic Information
| Provider Information | |||||||||
| NPI: | 1083656623 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIALYSIS SERVICES OF CENTRAL FLORIDA | ||||||||
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| OtherOrganizationName: | CENTRAL ORLANDO DSCF | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 UNION ST | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372191733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154670134 | ||||||||
| FaxNumber: | 6152343504 | ||||||||
| Practice Location | |||||||||
| Address1: | 2548 N ORANGE BLOSSOM TRL | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328044807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072465081 | ||||||||
| FaxNumber: | 4072465192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 02/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | YOUEU | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4078944693 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.