Prime Dialysis, LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

PRIME DIALYSIS, LLC

Practice address

12200 West Colonial Drive
Suite 102
Winter Garden, FL 34787

Phone

(954) 781-7741

Fax

(888) 349-8679

NPI assigned

Jun 8, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mimi Barrera

Title

Managing Member

Phone

(305) 778-8277

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496880000000",
    "number": "1063941565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 EAST SAMPLE ROAD",
            "address_2": "SUITE 220",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "33064",
            "telephone_number": "954-781-7741",
            "fax_number": "888-349-8679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 WEST COLONIAL DRIVE",
            "address_2": "SUITE 102",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "34787",
            "telephone_number": "954-781-7741",
            "fax_number": "888-349-8679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME DIALYSIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-08",
        "last_updated": "2017-06-08",
        "status": "A",
        "authorized_official_last_name": "BARRERA",
        "authorized_official_first_name": "MIMI",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "305-778-8277",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Winter Garden, FL
• Providers in Winter Garden, FL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.