Basic Information
| Provider Information | |||||||||
| NPI: | 1699709824 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIALYSIS PARTNERS 1 INC. | ||||||||
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| OtherOrganizationName: | NEPHROLOGY CONSULTANTS DIALYSIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 KISSIMMEE PARK RD | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347691547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074980018 | ||||||||
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| Practice Location | |||||||||
| Address1: | 220 KISSIMMEE PARK RD | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347691547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074980018 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | LARRANAGA | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4074980018 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 06155284 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.