MAGNOLIA DIALYSIS LLC NPI 1194125773

NPI Information

NPI: 1194125773
Provider Name: MAGNOLIA DIALYSIS LLC

Doing Business As: MANASOTA DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 10D2086094

Address:
6960 PROFESSIONAL PKWY E
UNITS 4 & 5
SARASOTA, FL
ZIP 34240
Phone: (941) 362-2864
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MAGNOLIA DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Sarasota, FL. MAGNOLIA DIALYSIS LLC NPI is 1194125773. The provider is registered as an organization entity type.
The provider Is Doing Business As Manasota Dialysis.

The provider's business location address is:

6960 PROFESSIONAL PKWY E
UNITS 4 & 5
SARASOTA, FL
ZIP 34240-428
Phone: (941) 362-2864
Fax: (941) 907-4720

The provider's authorized official is Samuel Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 10D2086094 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/2/2014 and was last updated on 11/10/2023.

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
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	014861600	MEDICAID	FLORIDA

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: 4/28/2024

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