Basic Information
| Provider Information | |||||||||
| NPI: | 1790009165 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RENAL ACCESS OF CENTRAL FLORIDA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 807 S ORLANDO AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327894870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078944693 | ||||||||
| FaxNumber: | 4075390469 | ||||||||
| Practice Location | |||||||||
| Address1: | 337 S NORTHLAKE BLVD | ||||||||
| Address2: | SUITE 1002 | ||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327015264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078944693 | ||||||||
| FaxNumber: | 4075390469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2010 | ||||||||
| LastUpdateDate: | 03/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | AYCRIGG | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4078944693 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.