Provider Demographics
NPI:1063814333
Name:VESTAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:VESTAL HEALTHCARE, LLC
Other - Org Name:SARATOGA SPRINGS DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AND TREASUER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:373 CHURCH ST.
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8626
Mailing Address - Country:US
Mailing Address - Phone:518-434-6565
Mailing Address - Fax:518-434-6611
Practice Address - Street 1:373 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8626
Practice Address - Country:US
Practice Address - Phone:518-434-6565
Practice Address - Fax:518-434-6611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-18
Last Update Date:2015-04-16
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
NY332719Medicare Oscar/Certification