Jacksonville Kidney Center LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

ME 98954 Issued in FL

Legal business name

JACKSONVILLE KIDNEY CENTER LLC

Practice address

13241 Bartram Park Blvd Unit 409
Jacksonville, FL 32258-5237

Phone

(904) 400-6800

NPI assigned

Aug 25, 2010

Organization subpart

No

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

Authorized official

Name

Koteswari Kancha, MDNPI 1407937170

Title

President

Phone

(904) 647-8207

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Taskett Dialysis LLC

  dba Philips Highway Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Jacksonville, FL
  • NPI 1043775331

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Koteswari Kancha, MD

  • Nephrology Physician
  • Jacksonville, FL
  • NPI 1407937170
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1282694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481155200000",
    "number": "1255647491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10036 DEERCREEK CLUB RD E",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561457",
            "telephone_number": "904-402-5137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD UNIT 409",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585237",
            "telephone_number": "904-400-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE KIDNEY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-25",
        "last_updated": "2016-12-08",
        "status": "A",
        "authorized_official_last_name": "KANCHA",
        "authorized_official_first_name": "KOTESWARI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-647-8207",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME 98954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacksonville Impotence Treatment Center (Jitc)
• Jacksonville Injury Treatment Center LLC
• Jacksonville Institute of Family Care, P.a.
• Jacksonville Integrative Health LLC
• Jacksonville Internal Medicine
• Jacksonville Kids Pediatrics LLC
• Jacksonville Lung Clinic PLLC
• Jacksonville Management and Staffing
• Jacksonville Medical & Wellness Massage, Inc.
• Jacksonville Mobile Imaging Services Inc

• Nephrology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Nephrology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; 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.