Organization
PENSACOLA NEPHROLOGY PA
Active
Parent organization
PENSACOLA NEPHROLOGY PA
Other names
Renalus Center for Kidney Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENSACOLA NEPHROLOGY PA
Authorized official
SAVANNA VAN BRUSSEL (ADMINISTRATION)
(850) 444-4700
Entity
Organization
Contact information
Practice address
6001 INDUSTRIAL BLVD, CENTURY, FL 32535-3312
(850) 444-4700
(850) 444-9766
Mailing address
PO BOX 11037, PENSACOLA, FL 32524-1037
(850) 444-7000
(850) 434-8144
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0358
MED3000/HEALTH 1ST NETWOR
FL
05
—
256870500
—
FL
05
—
256870501
—
FL
05
—
256870502
—
FL
05
—
256870503
—
FL
05
—
256870504
—
FL
05
—
256870505
—
FL
05
—
256870506
—
FL
05
—
256870507
—
FL
05
—
256870508
—
FL
05
—
529904030
—
AL
01
—
99659
BCBS OF FLORIDA
FL
01
—
CF9776
RR MEDICARE
—
Enumeration date
06/15/2006
Last updated
01/22/2025
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