Provider Demographics
NPI:1306149737
Name:ELITE PERITONEAL DIALYSIS OF MIAMI BEACH,LLC
Entity type:Organization
Organization Name:ELITE PERITONEAL DIALYSIS OF MIAMI BEACH,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VERBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-318-3169
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:400
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-531-1664
Mailing Address - Fax:954-391-8913
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:400
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-531-1664
Practice Address - Fax:954-391-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment