Organization
MIDDLEBURG DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA ANNE BRADY (CHIEF NURSING OFFICER)
(208) 371-7878
Entity
Organization
Contact information
Practice address
2070 PALMETTO ST STE 9, MIDDLEBURG, FL 32068-5198
(904) 406-5560
(904) 406-5559
Mailing address
2070 PALMETTO ST STE 9, MIDDLEBURG, FL 32068-5198
(904) 406-5560
(904) 406-5559
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
—
891397800
—
FL
Enumeration date
07/13/2006
Last updated
01/11/2023
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