Organization
KIDNEY LIFE INCORPORATED
Active
Other names
Seminole Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOSSETTE S MALTI RN (CEO PRESIDENT)
(727) 896-5500
Entity
Organization
Contact information
Practice address
10755 PARK BLVD, SUITE B, SEMINOLE, FL 33772-5420
(727) 393-5551
(727) 398-1971
Mailing address
PO BOX 47069, ST PETERSBURG, FL 33743-7069
(727) 589-6550
(727) 898-5317
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
—
200573500
—
FL
01
—
V19
BCBS FL
FL
Enumeration date
02/09/2007
Last updated
04/23/2012
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