Provider Demographics
NPI:1275974115
Name:FRESENIUS MEDICAL CARE OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE OF ILLINOIS, LLC
Other - Org Name:FRESENIUS MEDICAL CARE NORTHFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:480 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3016
Mailing Address - Country:US
Mailing Address - Phone:847-441-4031
Mailing Address - Fax:847-441-5017
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3016
Practice Address - Country:US
Practice Address - Phone:847-441-4031
Practice Address - Fax:847-441-5017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment