Provider Demographics
NPI:1891788550
Name:CENTRAL FLORIDA KIDNEY CENTERS INC
Entity type:Organization
Organization Name:CENTRAL FLORIDA KIDNEY CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZSUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-843-6110
Mailing Address - Street 1:203 ERNESTINE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3621
Mailing Address - Country:US
Mailing Address - Phone:407-843-6110
Mailing Address - Fax:407-425-1526
Practice Address - Street 1:14522 LANDSTAR BLVD
Practice Address - Street 2:UNIT 108
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-6450
Practice Address - Country:US
Practice Address - Phone:407-843-6110
Practice Address - Fax:407-425-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2025-05-07
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
FL212045300Medicaid
FL212045300Medicaid