Provider Demographics
NPI:1699167072
Name:RENAL CARE OF EUFAULA LLC
Entity type:Organization
Organization Name:RENAL CARE OF EUFAULA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-499-1059
Mailing Address - Street 1:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-1685
Mailing Address - Country:US
Mailing Address - Phone:727-499-1060
Mailing Address - Fax:727-287-6305
Practice Address - Street 1:820 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1822
Practice Address - Country:US
Practice Address - Phone:727-499-1059
Practice Address - Fax:727-287-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment