Advanced Kidney Care of Central
Organization Active NPI Nephrology Physician · Clermont, FL
NPI 1144533175 · NPPES record last updated Jan 12, 2012
Key facts
- NPI
- 1144533175
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- ME101771 (FL)
- Legal business name
- ADVANCED KIDNEY CARE OF CENTRAL
- Practice address
- 3175 Citrus Tower Blvd
Clermont, FL 34711-6803 - Phone
- (612) 396-8602
- NPI assigned
- Jul 19, 2010
- Organization subpart
- No
Authorized official
- Name
- Bao Long Huynh, MD
- Title
- President
- Phone
- (612) 396-8602
Practitioners 6
-
Bao L Huynh, MD
-
Usman Lone, M.D.
-
Mohammed Said Malas, M.D.
-
Milton Francois Ray, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101025000388 | FL | Part B Supplier - Clinic/Group Practice | 1951594761 |
Receives reassigned benefits from 5 practitioners Practice locations: Bartow, FL; Clermont, FL; Davenport, FL; Lake Wales, FL; Lakeland, FL |
National Provider Directory
Locations
3175 Citrus Tower Blvd
#C
Clermont, FL 34711
Phone (352) 240-3812
3175 Citrus Tower Blvd
Ste A
Clermont, FL 34711
2310 North Blvd W
Davenport, FL 33837
Phone (352) 240-3812
1749 6th St NW
Bldg 10
Winter Haven, FL 33881
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | ME101771 | FL | |
| Nephrology Physician |
207RN0300X | ME101771 | FL | Yes |
Addresses
Primary practice location
3175 Citrus Tower Blvd
Clermont, FL 34711-6803
Mailing address
3175 Citrus Tower Blvd
Clermont, FL 34711-6803
Phone (352) 240-3812
Other providers in Clermont, FL
- Advanced Faces, LLC
- Advanced Imaging Center of Clermont, Inc.
- Advanced Imaging Center of Leesburg,LLC
- Advanced Infectious Diseases &Wound Care Specialist LLC
- Advanced Integrated Pain & Spine Solutions
- Advanced Practitioner Services
- Advanced Practitioner Services LLC
- Advanced Speech & Rehab Services, LLC
- Adventist Health System /Sunbelt, Inc.
- Adventist Health System Sunbelt, Inc
All providers in Clermont, FL · Nephrology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.