Kidney Life Incorporated

Primary specialty

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

Legal business name

KIDNEY LIFE INCORPORATED

Doing business as

Seminole Dialysis Center

Practice address

10755 Park Blvd
Suite B
Seminole, FL 33772-5420

Phone

(727) 393-5551

Fax

(727) 398-1971

NPI assigned

Feb 9, 2007

Last updated

Apr 23, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Jossette S Malti, RN

Title

Ceo President

Phone

(727) 896-5500

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Seminole Dialysis Center Doing business as

Locations

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335139200000",
    "number": "1760523294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47069",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337437069",
            "telephone_number": "727-589-6550",
            "fax_number": "727-898-5317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10755 PARK BLVD",
            "address_2": "SUITE B",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337725420",
            "telephone_number": "727-393-5551",
            "fax_number": "727-398-1971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY LIFE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2012-04-23",
        "status": "A",
        "authorized_official_last_name": "MALTI",
        "authorized_official_first_name": "JOSSETTE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO PRESIDENT",
        "authorized_official_telephone_number": "727-896-5500",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200573500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "V19",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seminole Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Kelzer, LCSW
• Kerry Sanchez MD PA
• Ashti Devi Khargu, APRN
• Khylas Care LLC
• Richard Charles Kidd, DO
• Kristine Judith King, LCSW
• William Joseph Kinzler, DDS, MAGD
• Lance Scott Kittay, MPT
• Ryan Andrew Klepko, DC
• Laura Ann Koberda

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Seminole, FL
• Providers in Seminole, 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 Apr 23, 2012; 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.