Organization
KIDNEY CENTER OF TRADITION LLC
Active
Organization
KIDNEY CENTER OF TRADITION LLC
Active
Other names
GATLIN KIDNEY CARE
Organization subpart
No
Provider details
NPI number
Authorized official
KEISHA DENISE GREENE (VP OF CLINICAL & REGULATORY)
(978) 522-3905
Entity
Organization
Contact information
Practice address
1631 SW GATLIN BLVD, SUITE 100, PORT ST LUCIE, FL 34953-4103
(772) 343-7425
(772) 343-7687
Mailing address
1631 SW GATLIN BLVD, SUITE 100, PORT ST LUCIE, FL 34953-4103
(772) 343-7425
(772) 343-7687
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
08/28/2017
Last updated
08/18/2022
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