Provider Demographics
NPI:1063028124
Name:FRESENIUS MEDICAL CARE TUBA CITY, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE TUBA CITY, LLC
Other - Org Name:FRESENIUS KIDNEY CARE TUBA CITY
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 1:50 S MAIN STREET
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0000
Mailing Address - Country:US
Mailing Address - Phone:928-225-3388
Mailing Address - Fax:928-851-6220
Practice Address - Street 1:50 S MAIN STREET
Practice Address - Street 2:SUITE 108
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0000
Practice Address - Country:US
Practice Address - Phone:928-225-3388
Practice Address - Fax:928-851-6220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment