Organization Name: | CLERMONT DIALYSIS CENTER, LLC |
NPI Number: | 1346352184 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK FAWCETT (TREASURER) |
Mailing Address: | 312 Mohawk Rd Minneola |
State: | FL US |
Postal Code: | 347157434 |
Phone Number: | 3522431200 |
Fax Number: | |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |