Provider Demographics
NPI:1437458734
Name:FRESENIUS MEDICAL CARE WEST WILLOW, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE WEST WILLOW, LLC
Other - Org Name:FRESENIUS MEDICAL CARE WEST WILLOW
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 1:1444 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-1503
Mailing Address - Country:US
Mailing Address - Phone:773-772-4079
Mailing Address - Fax:773-772-4680
Practice Address - Street 1:1444 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-1503
Practice Address - Country:US
Practice Address - Phone:773-772-4079
Practice Address - Fax:773-772-4680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-25
Last Update Date:2023-10-17
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
IL142730Medicare Oscar/Certification