Provider Demographics
NPI:1376981795
Name:FRESENIUS MEDICAL CARE SAN ANTONIO, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE SAN ANTONIO, LLC
Other - Org Name:BROADWAY KIDNEY DISEASE CENTER
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 1:8840 TRADEWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6115
Mailing Address - Country:US
Mailing Address - Phone:210-805-9880
Mailing Address - Fax:210-805-8856
Practice Address - Street 1:8840 TRADEWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6115
Practice Address - Country:US
Practice Address - Phone:210-805-9880
Practice Address - Fax:210-805-8856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-07
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452816Medicare Oscar/Certification