Provider Demographics
NPI:1164943833
Name:FRESENIUS KIDNEY CARE BRISTOW, LLC
Entity Type:Organization
Organization Name:FRESENIUS KIDNEY CARE BRISTOW, LLC
Other - Org Name:FRESENIUS KIDNEY CARE BRISTOW
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 1:402 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-3204
Mailing Address - Country:US
Mailing Address - Phone:918-771-4093
Mailing Address - Fax:918-771-4137
Practice Address - Street 1:402 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-3204
Practice Address - Country:US
Practice Address - Phone:918-771-4093
Practice Address - Fax:918-771-4137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-03
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment