Basic Information
| Provider Information | |||||||||
| NPI: | 1235173006 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIALYSIS SER CENTRAL FLORIDA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | APOPKA DSCF | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 UNION STREET | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154670134 | ||||||||
| FaxNumber: | 6152343504 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 EXECUTIVE PARK | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073898980 | ||||||||
| FaxNumber: | 4073898984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 05/28/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YOUELL | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4078944693 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| 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 |
ID Information
| ID | Type | State | Issuer | Description | 301411 | 01 | FL | AVMED | OTHER |