Provider Demographics
NPI:1376879957
Name:FRESENIUS MEDICAL CARE NEPHROLOGY PARTNERS RENAL CARE CENTERS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE NEPHROLOGY PARTNERS RENAL CARE CENTERS, LLC
Other - Org Name:FRESENIUS MEDICAL CARE NEPHROLOGY GOSHEN
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 1:2257 KARISA DR STE 1
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6942
Mailing Address - Country:US
Mailing Address - Phone:574-533-9031
Mailing Address - Fax:574-535-1089
Practice Address - Street 1:2257 KARISA DR STE 1
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6942
Practice Address - Country:US
Practice Address - Phone:574-533-9031
Practice Address - Fax:574-535-1089
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-02
Last Update Date:2024-04-04
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
IN200976720GMedicaid