Organization
DIALYSIS & KIDNEY CENTER OF NORTH BREVARD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANETTE P DEE RN (ADMINISTRATOR)
(321) 269-6270
Entity
Organization
Contact information
Practice address
830 CENTURY MEDICAL DR, SUITE C, TITUSVILLE, FL 32796-2149
(321) 269-6270
(321) 383-1625
Mailing address
PO BOX 1067, MIMS, FL 32754-1067
(321) 269-6270
(321) 383-1625
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
05 0904
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0899219
AETNA
FL
05
—
210743100
—
FL
01
—
V4G
BLUE SHIELD
FL
Enumeration date
08/28/2006
Last updated
06/03/2010
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