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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