Universal Kidney Center of Boynton Beach Inc

Primary specialty

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

License

CLEA LIC # 800017018 Issued in FL

Legal business name

UNIVERSAL KIDNEY CENTER OF BOYNTON BEACH INC

Practice address

4895 Windward Passage Drive
Suite #5
Boynton Beach, FL 33436-7741

Phone

(561) 740-1981

Fax

(561) 732-8288

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Elmo Angelo V Bartolome

Title

Cfo Coo

Phone

(954) 770-6540

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1245342658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4895 WINDWARD PASSAGE DRIVE",
            "address_2": "SUITE #5",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334367741",
            "telephone_number": "561-740-1981",
            "fax_number": "561-732-8288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4895 WINDWARD PASSAGE DRIVE",
            "address_2": "SUITE #5",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334367741",
            "telephone_number": "561-740-1981",
            "fax_number": "561-732-8288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSAL KIDNEY CENTER OF BOYNTON BEACH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "BARTOLOME",
        "authorized_official_first_name": "ELMO",
        "authorized_official_middle_name": "ANGELO V",
        "authorized_official_title_or_position": "CFO COO",
        "authorized_official_telephone_number": "954-770-6540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "FL",
            "license": "CLEA LIC # 800017018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "VE9",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890071000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Boynton Beach, FL
• Providers in Boynton Beach, 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 Oct 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.