Provider Demographics
NPI:1386035517
Name:FRESENIUS MEDICAL CARE MONMOUTH, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE MONMOUTH, LLC
Other - Org Name:FRESENIUS MEDICAL CARE MAPLE CITY
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 1:1225 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-1210
Mailing Address - Country:US
Mailing Address - Phone:309-734-4270
Mailing Address - Fax:309-734-6263
Practice Address - Street 1:1225 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-1210
Practice Address - Country:US
Practice Address - Phone:309-734-4270
Practice Address - Fax:309-734-6263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-10
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment