KIDNEY CLINIC OF JACKSONVILLE, LLC (NPI# 1427281971) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427281971 |
| Entity Type | Organization |
| Organization Name | KIDNEY CLINIC OF JACKSONVILLE, LLC |
| Practice Address |
14546 Old Saint Augustine Rd 301 Jacksonville FL 32258-5468 |
| Practice Telephone | 9042968980 |
| Practice Fax Number | 9042960698 |
| Mailing Telephone | 9042968980 |
| Mailing Fax Number | 9042960698 |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2009-12-31 |
| Authorized Official Name | KADIR MANSUR (PRESIDENT/CO-OWNER) |
| Authorized Official Telephone | 9042968980 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| Street Address |
14546 OLD SAINT AUGUSTINE RD 301 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32258-5468 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437154804 | Kyle G Corbin | Physical Therapist | 14546 Old Saint Augustine Rd, Suite 209, Jacksonville, FL 32258-5468 | 2005-06-14 |
| 1881208593 | Aaron Bailey | Registered Nurse | 14546 Old Saint Augustine Rd, Jacksonville, FL 32258-5468 | 2020-09-01 |
| 1801354675 | Morgen Rachel Fletcher | Physician Assistant | 14546 Old Saint Augustine Rd, Jacksonville, FL 32258-5468 | 2019-03-11 |
| 1467988246 | Fridah Kirimi | Nurse Practitioner | 14546 Old Saint Augustine Rd, Bldg 1 Suite 317, Jacksonville, FL 32258-5468 | 2017-05-11 |
| 1275901878 | Paul David Provenzano | Physical Therapist | 14546 Old Saint Augustine Rd, Jacksonville, FL 32258-5468 | 2015-09-14 |
| 1992188825 | Julianne Bryce | Physical Therapist | 14546 Old Saint Augustine Rd, Suite 209, Jacksonville, FL 32258-5468 | 2015-07-09 |
| 1174954630 | Ashley B Burton | Social Worker | 14546 Old Saint Augustine Rd, Bldg 1 Suite 317, Jacksonville, FL 32258-5468 | 2013-12-10 |
| 1376895888 | Cancer Specialists LLC | Durable Medical Equipment & Medical Supplies | 14546 Old Saint Augustine Rd, Bldg 1 Suite 317, Jacksonville, FL 32258-5468 | 2012-10-08 |
| 1245591114 | Amber Rose Schueler Whitehead | Massage Therapist | 14546 Old Saint Augustine Rd, Suite 403, Jacksonville, FL 32258-5468 | 2012-06-06 |
| 1790051845 | Baptist Cardiology, Inc. | Internal Medicine | 14546 Old Saint Augustine Rd, Suite 103, Jacksonville, FL 32258-5468 | 2012-03-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437794237 | Nicoleta Descalzo | Behavior Technician | 12724 Grand Bay Parkway West, Suite 410, Jacksonville, FL 32258 | 2019-11-15 |
| 1992275572 | William Lundgren | Nurse Anesthetist, Certified Registered | 3625 University Blvd South, Jacksonville, FL 32258 | 2018-11-27 |
| 1104301159 | Emergency Physicians Inc | Emergency Medicine | 14534 Old St Augustine Rd, Suite 3110, Jacksonville, FL 32258 | 2018-09-26 |
| 1679092886 | Palm Life Medical Associates Pa | Assisted Living Facility | 12494 Acosta Oaks Drive, Jacksonville, FL 32258 | 2017-09-19 |
| 1679013932 | Optometry Vision Care Pllc | Optometrist | 14866 Old St. Augustine Rd Unit 110, Jacksonville, FL 32258 | 2017-03-06 |
| 1467991950 | North Florida Vision Group Inc | Optometrist | 14866 Old St. Augustine Rd., Suite 110, Jacksonville, FL 32258 | 2017-02-16 |
| 1124576566 | Revolution Chiropractic LLC | Chiropractor | 14866 Old St Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-14 |
| 1396291936 | Robyn Reaves | Nurse Practitioner | 12361 Richards Glen Ct, Jacksonville, FL 32258 | 2016-09-01 |
| 1326595927 | Lauren Cost | Chiropractor | 14866 Old St. Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-01 |
| 1487991170 | Mark Steven Colosimo | Pharmacist | 13820 Old St Augustine Road, Jacksonville, FL 32258 | 2013-01-15 |
| Find all providers in zip 32258 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629499090 | Pro-med Collectors LLC | Internal Medicine | 1907 Atlantic Blvd, Jacksonville, FL 32207-3466 | 2014-01-02 |
| 1821275330 | Nephrology Consultants of Jacksonville LLC | Internal Medicine | 3129 Hendricks Ave, Jacksonville, FL 32207-4217 | 2008-01-28 |
| 1457455719 | Andrew Wasiluk | Internal Medicine | 3129 Hendricks Avenue, Jacksonville, FL 32207-4217 | 2006-09-08 |
| 1811924210 | Naeem Haider | Internal Medicine | 3599 University Blvd So, Suite 805, Jacksonville, FL 32216 | 2006-06-28 |
| 1265474209 | Koithara Varkey Thomas | Internal Medicine | Eastern Nephrology Associates, 277 Memorial Drive, Jacksonville, NC 28546-6333 | 2006-06-12 |
| 1457917304 | Cardiorenal Therapeutics LLC | Internal Medicine | 6817 Southpoint Pkwy Ste 203, Jacksonville, FL 32216-6286 | 2019-05-16 |
| 1619434586 | Md. Irtiza Hasan | Internal Medicine | 655 W 8th St Fl 4, Jacksonville, FL 32209-6511 | 2019-02-26 |
| 1578058939 | Nephrology Consultants of Jacksonville LLC | Internal Medicine | 3129 Hendricks Ave, Jacksonville, FL 32207-4217 | 2018-06-28 |
| 1396283628 | A Abdalla, Inc | Internal Medicine | 5685 Norwood Ave, Jacksonville, FL 32208-5012 | 2017-02-07 |
| 1982141412 | Universal Kidney Care LLC | Internal Medicine | 10752 Deerwood Park Blvd Ste 100, Jacksonville, FL 32256-4846 | 2017-01-23 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32258 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.