Provider Demographics
NPI:1265041479
Name:FRESENIUS MEDICAL CARE SNAKE RIVER, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE SNAKE RIVER, LLC
Other - Org Name:FRESENIUS KIDNEY CARE SNAKE RIVER
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 1:3195 S. FORK BLVD
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1296
Mailing Address - Country:US
Mailing Address - Phone:208-357-4870
Mailing Address - Fax:208-242-4059
Practice Address - Street 1:3195 S. FORK BLVD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1296
Practice Address - Country:US
Practice Address - Phone:208-357-4870
Practice Address - Fax:208-242-4059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment