Kidney Clinic of Jacksonville, LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

KIDNEY CLINIC OF JACKSONVILLE, LLC

Practice address

14546 Old Saint Augustine Rd
301
Jacksonville, FL 32258-5468

Phone

(904) 296-8980

Fax

(904) 296-0698

NPI assigned

Sep 1, 2009

Organization subpart

No

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

Authorized official

Name

Kadir Mansur, MD

Title

President/Co-Owner

Phone

(904) 296-8980

Specialties & licenses 1

Addresses

Locations

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
  NPD (past)

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

{
    "created_epoch": "1251763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262217600000",
    "number": "1427281971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14546 OLD SAINT AUGUSTINE RD",
            "address_2": "301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585468",
            "telephone_number": "904-296-8980",
            "fax_number": "904-296-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14546 OLD SAINT AUGUSTINE RD",
            "address_2": "301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585468",
            "telephone_number": "904-296-8980",
            "fax_number": "904-296-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CLINIC OF JACKSONVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-01",
        "last_updated": "2009-12-31",
        "status": "A",
        "authorized_official_last_name": "MANSUR",
        "authorized_official_first_name": "KADIR",
        "authorized_official_title_or_position": "PRESIDENT/CO-OWNER",
        "authorized_official_telephone_number": "904-296-8980",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenyetta Elaine Kidd
• Tiffany Kidd, ATC
• Laura E Kidder, APRN
• Rachel Kidder, RN
• Cynthia Kiddey, APRN
• Kidney Clinic of North Florida PLLC
• Kidney Kare of Jacksonville FL, Inc.
• Kids and Families Medical Clinic LLC
• Kids First Dentistry,Inc
• Victor Kiebalo, MD

• 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 31, 2009; 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.