Provider Demographics
NPI:1871573451
Name:PEMBROKE PINES ARTIFICIAL KIDNEY CENTER INC
Entity type:Organization
Organization Name:PEMBROKE PINES ARTIFICIAL KIDNEY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURRIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:954-474-7701
Mailing Address - Street 1:7061 CYPRESS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2243
Mailing Address - Country:US
Mailing Address - Phone:954-474-7701
Mailing Address - Fax:954-474-7702
Practice Address - Street 1:12145 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1727
Practice Address - Country:US
Practice Address - Phone:954-435-2553
Practice Address - Fax:954-435-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL210408300Medicaid
FLV3YOtherBC/BS PROVIDER NO
FL10-2647Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO