Organization
BIG LAKE KIDNEY CENTER LLC
Active
Organization
BIG LAKE KIDNEY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEISHA DENISE GREENE (VP OF CLINICAL & REGULATORY)
(978) 522-3905
Entity
Organization
Contact information
Practice address
3240 HIGHWAY 441 S, OKEECHOBEE, FL 34974-6239
(863) 824-0225
(863) 824-0226
Mailing address
3240 HIGHWAY 441 S, OKEECHOBEE, FL 34974-6239
(863) 824-0225
(863) 824-0226
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
—
004431900
—
FL
Enumeration date
06/13/2011
Last updated
08/18/2022
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