Organization
CORVA CLINICS, LLC - MIAMI SHORES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY SIMONSEN (CEO)
(720) 402-3881
Entity
Organization
Contact information
Practice address
9999 NE 2ND AVE, MIAMI SHORES, FL 33138-2352
(305) 756-4400
Mailing address
5613 DTC PKWY, SUITE 800, GREENWOOD VILLAGE, CO 80111-3028
(720) 402-3881
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102800
MEDICARE PROVIDER NUMBER
FL
Enumeration date
08/27/2012
Last updated
08/27/2012
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