Provider Demographics
NPI:1023367893
Name:ROSE CITY DIALYSIS, LLC
Entity Type:Organization
Organization Name:ROSE CITY DIALYSIS, LLC
Other - Org Name:FRESENIUS MEDICAL CARE MAYWOOD PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:11909 NE GLENN WIDING DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-9099
Mailing Address - Country:US
Mailing Address - Phone:503-255-3464
Mailing Address - Fax:503-254-6160
Practice Address - Street 1:11909 NE GLENN WIDING DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9099
Practice Address - Country:US
Practice Address - Phone:503-255-3464
Practice Address - Fax:503-254-6160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-07
Last Update Date:2023-10-17
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
OR38-2561OtherPTAN