Provider Demographics
NPI:1073944427
Name:FRESENIUS MEDICAL CARE OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE OF ILLINOIS, LLC
Other - Org Name:FRESENIUS MEDICAL CARE PEKIN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:2355 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3902
Mailing Address - Country:US
Mailing Address - Phone:309-347-1632
Mailing Address - Fax:309-347-1636
Practice Address - Street 1:2355 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3902
Practice Address - Country:US
Practice Address - Phone:309-347-1632
Practice Address - Fax:309-347-1636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-11
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment