| Entity Name: | UNIVERSAL KIDNEY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Mar 1997 (28 years ago) |
| Document Number: | P97000019333 |
| FEI/EIN Number | 650762194 |
| Address: | 4875 NE 20TH TERRACE, FT. LAUDERDALE, FL, 33308 |
| Mail Address: | 4875 NE 20TH TERRACE, FT. LAUDERDALE, FL, 33308 |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447362835 | 2006-08-31 | 2012-05-22 | 4875 NE 20TH TERRACE, FL LAUDERDALE, FL, 333084515, US | 4875 NE 20TH TERRACE, FL LAUDERDALE, FL, 333084515, US | |||||||||||||||||||||||||||||
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| Phone | +1 954-958-9300 |
| Fax | 9543184086 |
Authorized person
| Name | MR. ELMO ANGELO V BARTOLOME |
| Role | CFO COO |
| Phone | 9549589300 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | CLEA LIC # 800001259 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FL |
| Number | V9E |
| Issuer | MEDICAID |
| Number | 212511100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BARTOLOME ELMO | Agent | 4875 NE 20TH TERRACE, FT. LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| BARTOLOME ELMO A | President | 4875 NE 20TH TERRACE, FT. LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| BARTOLOME ELMO A | Secretary | 4875 NE 20TH TERRACE, FT. LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| BARTOLOME ELMO A | Treasurer | 4875 NE 20TH TERRACE, FT. LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| BARTOLOME ELMO A | Director | 4875 NE 20TH TERRACE, FT. LAUDERDALE, FL, 33308 |
| BARTOLOME DELILAH | Director | 4875 NE 20TH TERRACE, FORT LAUDERDALE, FL, 33308 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
