Provider Demographics
NPI:1609217157
Name:FRESENIUS MEDICAL CARE WEST SAHARA, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE WEST SAHARA, LLC
Other - Org Name:FRESENIUS MEDICAL CARE LAKE MEADE NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
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 1:1581 MOUNT MARIAH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-1504
Mailing Address - Country:US
Mailing Address - Phone:702-647-4089
Mailing Address - Fax:702-647-4180
Practice Address - Street 1:1581 MOUNT MARIAH DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-1504
Practice Address - Country:US
Practice Address - Phone:702-647-4089
Practice Address - Fax:702-647-4180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV292519Medicare Oscar/Certification