Provider Demographics
NPI:1215196787
Name:QUALICENTERS INLAND NORTHWEST, LLC
Entity Type:Organization
Organization Name:QUALICENTERS INLAND NORTHWEST, LLC
Other - Org Name:FRESENIUS MEDICAL CARE LONGVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
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 1:5616 OCEAN BEACH HWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-6222
Mailing Address - Country:US
Mailing Address - Phone:360-425-2460
Mailing Address - Fax:
Practice Address - Street 1:5616 OCEAN BEACH HWY
Practice Address - Street 2:SUITE 260
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-6222
Practice Address - Country:US
Practice Address - Phone:360-425-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2012-08-02
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
WA502563Medicare Oscar/Certification