Provider Demographics
NPI:1467567222
Name:FRESENIUS MEDICAL CARE NEPHROLOGY AND INTERNAL MEDICINE DIALYSIS CENTE
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE NEPHROLOGY AND INTERNAL MEDICINE DIALYSIS CENTE
Other - Org Name:FRESENIUS MEDICAL CARE MORGAN COUNTY
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 1:2084 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1805
Mailing Address - Country:US
Mailing Address - Phone:765-349-9429
Mailing Address - Fax:765-349-9632
Practice Address - Street 1:2084 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1805
Practice Address - Country:US
Practice Address - Phone:765-349-9429
Practice Address - Fax:765-349-9632
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2014-12-12
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
IN152553Medicare Oscar/Certification