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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