Organization
UNIVERSAL KIDNEY CENTER INC
Active
Organization
UNIVERSAL KIDNEY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELMO ANGELO V BARTOLOME (CFO COO)
(954) 958-9300
Entity
Organization
Contact information
Practice address
4875 NE 20TH TERRACE, FL LAUDERDALE, FL 33308-4515
(954) 958-9300
(954) 318-4086
Mailing address
4875 NE 20TH TERRACE, FL LAUDERDALE, FL 33308-4515
(954) 958-9300
(954) 318-4086
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
CLEA LIC # 800001259
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212511100
—
FL
01
—
V9E
BCBS OF FL
—
Enumeration date
08/31/2006
Last updated
05/22/2012
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