Big Lake Kidney Center LLC

Primary specialty

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

Legal business name

BIG LAKE KIDNEY CENTER LLC

Practice address

3240 Highway 441 S
Okeechobee, FL 34974-6239

Phone

(863) 824-0225

Fax

(863) 824-0226

NPI assigned

Jun 13, 2011

Last updated

Aug 18, 2022By 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

Keisha Denise Greene

Title

VP of Clinical & Regulatory

Phone

(978) 522-3905

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1307923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1821383324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3240 HIGHWAY 441 S",
            "city": "OKEECHOBEE",
            "state": "FL",
            "postal_code": "349746239",
            "telephone_number": "863-824-0225",
            "fax_number": "863-824-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 HIGHWAY 441 S",
            "city": "OKEECHOBEE",
            "state": "FL",
            "postal_code": "349746239",
            "telephone_number": "863-824-0225",
            "fax_number": "863-824-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG LAKE KIDNEY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-13",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "VP OF CLINICAL & REGULATORY",
        "authorized_official_telephone_number": "978-522-3905"
    },
    "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": "004431900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Christine Brennan Bishop, OPTOMETRIST
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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Okeechobee, FL
• Providers in Okeechobee, 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 Aug 18, 2022; 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.