JACKSONVILLE KIDNEY CENTER LLC NPI 1255647491

NPI Information

  • NPI: 1255647491
  • Provider Name: JACKSONVILLE KIDNEY CENTER LLC
  • Classification: Internal Medicine - 207RN0300X
  • Specialization: Nephrology
  • Entity Type: Organization
  • Address: 13241 BARTRAM PARK BLVD UNIT 409
    JACKSONVILLE, FL
    ZIP 32258
  • Phone: (904) 400-6800

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NPI Details

JACKSONVILLE KIDNEY CENTER LLC is a nephrology internal medicine in Jacksonville, FL. The provider is 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. JACKSONVILLE KIDNEY CENTER LLC NPI is 1255647491. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

13241 BARTRAM PARK BLVD UNIT 409
JACKSONVILLE, FL
ZIP 32258-237
Phone: (904) 400-6800

The provider's authorized official is Koteswari Kancha .
The authorized official title is President and has the following contact phone number (904) 647-8207.

The enumeration date for this NPI number is 8/25/2010 and was last updated on 12/8/2016.

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
1207RN0300XInternal MedicineNephrologyME 98954FLORIDAYes

What is NPI?

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This page was last updated on: 11/21/2025

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