Provider Demographics
NPI:1477017515
Name:FRESENIUS MEDICAL CARE FOUR CORNERS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE FOUR CORNERS, LLC
Other - Org Name:FRESENIUS KIDNEY CARE FOUR CORNERS
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 1:503 CAGAN VIEW RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6468
Mailing Address - Country:US
Mailing Address - Phone:352-394-3003
Mailing Address - Fax:352-243-2350
Practice Address - Street 1:503 CAGAN VIEW RD STE 300
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6468
Practice Address - Country:US
Practice Address - Phone:352-394-3003
Practice Address - Fax:352-243-2350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-23
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment