Provider Demographics
NPI:1508563115
Name:FRESENIUS MEDICAL CARE WINTER LAKE, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE WINTER LAKE, LLC
Other - Org Name:FRESENIUS KIDNEY CARE WINTER LAKE
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 1:7325 CYPRESS GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3246
Mailing Address - Country:US
Mailing Address - Phone:863-269-4566
Mailing Address - Fax:863-201-8551
Practice Address - Street 1:7325 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3246
Practice Address - Country:US
Practice Address - Phone:863-269-4566
Practice Address - Fax:863-201-8551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-14
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment