Organization
GULF COAST KIDNEY CENTER INC
Active
Organization
GULF COAST KIDNEY CENTER INC
Active
Other names
Physicians Dialysis Trinity
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN JEGER (VICE PRESIDENT)
(305) 651-3261
Entity
Organization
Contact information
Practice address
9332 STATE ROAD 54, SUITE 306, TRINITY, FL 34655-1810
(727) 848-0106
(727) 848-7943
Mailing address
19559 NE 10TH AVE, N MIAMI BEACH, FL 33179-3501
(305) 651-3261
(305) 651-2961
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
05
—
209147000
—
FL
Enumeration date
06/23/2006
Last updated
05/20/2016
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