Provider Demographics
NPI:1417108754
Name:FRESENIUS MEDICAL CARE OAHU LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE OAHU LLC
Other - Org Name:FRESENIUS MEDICAL CARE WINDWARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:45-480 KANEOHE BAY DR
Mailing Address - Street 2:#D09
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2039
Mailing Address - Country:US
Mailing Address - Phone:808-235-0885
Mailing Address - Fax:808-235-1955
Practice Address - Street 1:45-480 KANEOHE BAY DR
Practice Address - Street 2:#D09
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2039
Practice Address - Country:US
Practice Address - Phone:808-235-0885
Practice Address - Fax:808-235-1955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
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
122502Medicare Oscar/Certification