PRIME DIALYSIS LLC NPI 1063941565

NPI Information

  • NPI: 1063941565
  • Provider Name: PRIME DIALYSIS, LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • CLIA Number: 10D2259544
  • Address: 12200 WEST COLONIAL DRIVE
    SUITE 102
    WINTER GARDEN, FL
    ZIP 34787
  • Phone: (954) 781-7741

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NPI Details

PRIME DIALYSIS, LLC is an end-stage renal disease (esrd) treatment clinic center in Winter Garden, FL. PRIME DIALYSIS, LLC NPI is 1063941565. The provider is registered as an organization entity type.

The provider's business location address is:

12200 WEST COLONIAL DRIVE
SUITE 102
WINTER GARDEN, FL
ZIP 34787
Phone: (954) 781-7741
Fax: (888) 349-8679

The provider's authorized official is Mimi Barrera .
The authorized official title is Managing Member and has the following contact phone number (305) 778-8277.

The CLIA number assigned to this NPI record is 10D2259544 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/8/2017 and was last updated on 6/8/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentFLORIDAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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