Basic Information
| Provider Information | |||||||||
| NPI: | 1861479040 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RENAL CAREPARTNERS OF DAVIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14361 COMMERCE WAY | ||||||||
| Address2: | 306 | ||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330161565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055120014 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4970 SW 52ND ST | ||||||||
| Address2: | 325 | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333145531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055120014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 09/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | LUGO | ||||||||
| AuthorizedOfficialFirstName: | ORESTES | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, CFO | ||||||||
| AuthorizedOfficialTelephone: | 3055120014 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.