Organization
UNIVERSAL KIDNEY CENTER OF BOYNTON BEACH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELMO ANGELO V BARTOLOME (CFO COO)
(954) 770-6540
Entity
Organization
Contact information
Practice address
4895 WINDWARD PASSAGE DRIVE, SUITE #5, BOYNTON BEACH, FL 33436-7741
(561) 740-1981
(561) 732-8288
Mailing address
4895 WINDWARD PASSAGE DRIVE, SUITE #5, BOYNTON BEACH, FL 33436-7741
(561) 740-1981
(561) 732-8288
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
CLEA LIC # 800017018
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890071000
—
FL
01
—
VE9
BCBS OF FL
FL
Enumeration date
08/31/2006
Last updated
10/06/2015
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