NPIMap

Organization Active NPI

Melbourne Kidney Center Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Melbourne, FL
National Provider Identifier
1104823731
Registry record updated Dec 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
MELBOURNE KIDNEY CENTER INC
Practice address
280 N Wickham Rd
Melbourne, FL 32935-8650
Phone
(321) 308-5005
Fax
(321) 308-5002
NPI assigned
Jun 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2010

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

Authorized official

Name
Mrs. Sadalia Bartman Gross, RN
Title
Administrator
Phone
(321) 724-0431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

280 N Wickham Rd
Melbourne, FL 32935-8650

Mailing address

280 N Wickham Rd
Melbourne, FL 32935-8650
Phone (321) 308-5005

Other names 1

  • HARBOR CITY DIALYSIS Doing business as

National Provider Directory

National Provider Directory

Locations

280 N Wickham Rd
Melbourne, FL 32935
Phone (321) 308-5005

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292976000000",
    "number": "1104823731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358650",
            "telephone_number": "321-308-5005",
            "fax_number": "321-308-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358650",
            "telephone_number": "321-308-5005",
            "fax_number": "321-308-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELBOURNE KIDNEY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2010-12-22",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "SADALIA",
        "authorized_official_middle_name": "BARTMAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-724-0431",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HARBOR CITY DIALYSIS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2010; 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.