Provider Demographics
NPI:1285607200
Name:DIALYSIS SER CENTRAL FLORIDA LLC
Entity type:Organization
Organization Name:DIALYSIS SER CENTRAL FLORIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:YOUELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-894-4693
Mailing Address - Street 1:511 UNION ST
Mailing Address - Street 2:STE 1800
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219
Mailing Address - Country:US
Mailing Address - Phone:615-467-0134
Mailing Address - Fax:615-234-2422
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:STE 537N
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-515-2200
Practice Address - Fax:407-515-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVJ6OtherBCBS
102823Medicare Oscar/Certification