Provider Demographics
NPI:1982700415
Name:UNIVERSAL KIDNEY CENTER OF DAVIE, INC.
Entity type:Organization
Organization Name:UNIVERSAL KIDNEY CENTER OF DAVIE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O/C.O.O
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMO ANGELO
Authorized Official - Middle Name:V
Authorized Official - Last Name:BARTOLOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-770-6540
Mailing Address - Street 1:11570 W STATE ROAD 84
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-4022
Mailing Address - Country:US
Mailing Address - Phone:954-727-9100
Mailing Address - Fax:954-727-9880
Practice Address - Street 1:11570 W STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-4022
Practice Address - Country:US
Practice Address - Phone:954-727-9100
Practice Address - Fax:954-727-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD1100XNursing Service ProvidersRegistered NurseDialysis, PeritonealGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10 2801Medicare ID - Type Unspecified