Provider Demographics
NPI:1275879058
Name:FRESENIUS MEDICAL CARE MIDWEST DIALYSIS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE MIDWEST DIALYSIS, LLC
Other - Org Name:FRESENIUS MEDICAL CARE MIDWEST RYAN ROAD
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 1:9420 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8242
Mailing Address - Country:US
Mailing Address - Phone:414-761-8080
Mailing Address - Fax:414-761-8953
Practice Address - Street 1:9420 S 22ND ST
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-8242
Practice Address - Country:US
Practice Address - Phone:414-761-8080
Practice Address - Fax:414-761-8953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-23
Last Update Date:2023-10-18
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
522528Medicare Oscar/Certification