Provider Demographics
NPI:1528047909
Name:BOCA/DELRAY RENAL ASSOCIATES, INC
Entity type:Organization
Organization Name:BOCA/DELRAY RENAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-988-7100
Mailing Address - Street 1:1905 CLINT MOORE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2658
Mailing Address - Country:US
Mailing Address - Phone:561-988-7100
Mailing Address - Fax:561-988-6120
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2658
Practice Address - Country:US
Practice Address - Phone:561-988-7100
Practice Address - Fax:561-988-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2009-04-01
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
FL212210300Medicaid
FLV7VOtherBCBS
FLV7VOtherBCBS