GATLIN KIDNEY CARE
NPI 1184141350
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Port St Lucie, FL

Q: What is Kidney Center Of Tradition LLC's NPI number?

The NPI number for Kidney Center Of Tradition LLC is 1184141350. It was assigned to this organization in the NPPES registry on August 28, 2017. The provider is doing business as Gatlin Kidney Care.

Q: What is Kidney Center Of Tradition LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Active since August 28, 2017CLIA 10D2130872 · Waiver

1631 SW GATLIN BLVD, SUITE 100, PORT ST LUCIE, FL 34953(772) 343-7425(772) 343-7687 Get Directions Write a Review

NPPES record last updated: August 18, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 18, 2022, Jul 21, 2022, Mar 16, 2020 and 2 more (5 updates tracked since 2017).

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About Gatlin Kidney Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GATLIN KIDNEY CARE (NPI 1184141350) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Port St Lucie, Florida and active in the NPI registry since August 2017. The organization holds a CLIA Waiver certificate valid through May 17, 2027 and lists Keisha Denise Greene, Vp Of Clinical & Regulatory, as its authorized official.

NPPES Registry Identity

NPI1184141350

Entity TypeOrganization

Primary Taxonomy261QE0700X

Legal Business NameKIDNEY CENTER OF TRADITION LLC

Location Address1631 SW GATLIN BLVD, SUITE 100Port St Lucie, FL 34953-4103

Mailing Address1631 Sw Gatlin Blvd, Suite 100Port St Lucie, FL 34953-4103 · (772) 343-7425 · Fax (772) 343-7687

Phone(772) 343-7425

Fax(772) 343-7687

Organization SubpartNo

Authorized OfficialKeisha Denise GreeneVp Of Clinical & Regulatory · (978) 522-3905

Enumeration DateAugust 28, 2017

Last NPPES UpdateAugust 18, 20225 updates tracked since enumeration

NPPES CertifiedAugust 18, 2022

✔ NPI 1184141350 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities

Taxonomy Code261QE0700X

1631 SW GATLIN BLVD, Port St Lucie, FL 34953

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Other Names 1

Doing Business AsGatlin Kidney Care

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2130872

Gatlin Kidney Care · Port Saint Lucie, FL

Active · expires May 17, 2027

CLIA Number10D2130872

Laboratory TypeEnd Stage Renal Disease Dialysis Facility

Certificate Effective DateMay 18, 2025

Certificate Expiration DateMay 17, 2027

Laboratory DirectorMohammad Izhar

Laboratory Phone(772) 873-2557

Laboratory LocationGatlin Kidney Care1631 SW Gatlin Blvd Suite 100, Port Saint Lucie, FL 34953

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kidney Center Of Tradition LLC's NPI number?

The NPI number for Kidney Center Of Tradition LLC is 1184141350. It was assigned to this organization in the NPPES registry on August 28, 2017. The provider is doing business as Gatlin Kidney Care.

Where is Kidney Center Of Tradition LLC located?

Kidney Center Of Tradition LLC is located at 1631 SW Gatlin Blvd Suite 100, Port St Lucie, FL 34953. The listed phone number is (772) 343-7425.

What is Kidney Center Of Tradition LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Does Kidney Center Of Tradition LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2130872) is associated with this NPI, valid through May 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kidney Center Of Tradition LLC was last updated on August 18, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.