Provider Demographics
NPI:1174635973
Name:FRESENIUS MEDICAL CARE DIALYSIS SERVICES COLORADO LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE DIALYSIS SERVICES COLORADO LLC
Other - Org Name:FRESENIUS MEDICAL CARE LAMAR DIALYSIS
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 1:108 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3711
Mailing Address - Country:US
Mailing Address - Phone:719-336-1170
Mailing Address - Fax:719-336-1171
Practice Address - Street 1:108 LEE AVE
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3711
Practice Address - Country:US
Practice Address - Phone:719-336-1170
Practice Address - Fax:719-336-1171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2023-10-24
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
CO062536Medicare Oscar/Certification