BIG LAKE KIDNEY CENTER LLC NPI 1821383324

NPI Information

NPI: 1821383324
Provider Name: BIG LAKE KIDNEY CENTER LLC
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 10D2024813

Address:
3240 HIGHWAY 441 S
OKEECHOBEE, FL
ZIP 34974
Phone: (863) 824-0225
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BIG LAKE KIDNEY CENTER LLC is an end-stage renal disease (esrd) treatment clinic center in Okeechobee, FL. BIG LAKE KIDNEY CENTER LLC NPI is 1821383324. The provider is registered as an organization entity type.

The provider's business location address is:

3240 HIGHWAY 441 S
OKEECHOBEE, FL
ZIP 34974-239
Phone: (863) 824-0225
Fax: (863) 824-0226

The provider's authorized official is Keisha Denise Greene .
The authorized official title is Vp Of Clinical & Regulatory and has the following contact phone number (978) 522-3905.

The CLIA number assigned to this NPI record is 10D2024813 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/13/2011 and was last updated on 8/18/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	004431900	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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