Provider Type Icon

RENAL CARE GROUP OF THE SOUTHEAST INC. NPI 1356453195


NPI Information

NPI: 1356453195
Provider Name: RENAL CARE GROUP OF THE SOUTHEAST, INC.

Doing Business As: FRESENIUS MEDICAL CARE CORDOVA

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 10D1000423

Address:
5401 CORPORATE WOODS DR STE 850
PENSACOLA, FL
ZIP 32504
Phone: (850) 484-8646
Get Directions

RENAL CARE GROUP OF THE SOUTHEAST, INC. is an end-stage renal disease (esrd) treatment clinic center in Pensacola, FL. RENAL CARE GROUP OF THE SOUTHEAST, INC. NPI is 1356453195. The provider is registered as an organization entity type.
The provider Is Doing Business As Fresenius Medical Care Cordova.

The provider's business location address is:

5401 CORPORATE WOODS DR STE 850
PENSACOLA, FL
ZIP 32504-907
Phone: (850) 484-8646
Fax: (850) 484-9011

The provider's authorized official is Barry L. Blanton .
The authorized official title is Vice President and has the following contact phone number (781) 699-9000.

The CLIA number assigned to this NPI record is 10D1000423 - end stage renal disease dialysis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/31/2006 and was last updated on 8/14/2021.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1890028100MEDICAIDFLORIDA

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: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.