NPIMap

Organization Active NPI

Dialysis & Kidney Center of North Brevard Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Titusville, FL
National Provider Identifier
1346358538
Registry record updated Jun 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
05 0904 Issued in FL
Legal business name
DIALYSIS & KIDNEY CENTER OF NORTH BREVARD INC
Practice address
830 Century Medical Dr
Suite C
Titusville, FL 32796-2149
Phone
(321) 269-6270
Fax
(321) 383-1625
NPI assigned
Aug 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2010

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

Authorized official

Name
Jeanette P Dee, RN
Title
Administrator
Phone
(321) 269-6270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 05 0904 FL Primary

Addresses

Primary practice location

830 Century Medical Dr
Suite C
Titusville, FL 32796-2149

Mailing address

PO Box 1067
Mims, FL 32754-1067
Phone (321) 269-6270

Other identifiers 3

IdentifierTypeStateIssuer
0899219OtherFLAETNA
V4GOtherFLBLUE SHIELD
210743100MedicaidFL

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275523200000",
    "number": "1346358538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1067",
            "city": "MIMS",
            "state": "FL",
            "postal_code": "327541067",
            "telephone_number": "321-269-6270",
            "fax_number": "321-383-1625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 CENTURY MEDICAL DR",
            "address_2": "SUITE C",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962149",
            "telephone_number": "321-269-6270",
            "fax_number": "321-383-1625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIALYSIS & KIDNEY CENTER OF NORTH BREVARD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2010-06-03",
        "status": "A",
        "authorized_official_last_name": "DEE",
        "authorized_official_first_name": "JEANETTE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-269-6270",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "FL",
            "license": "05 0904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0899219",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "V4G",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210743100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.