Provider Demographics
NPI:1710155361
Name:FRESENIUS MEDICAL CARE COMPREHENSIVE CKD SERVICES INC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE COMPREHENSIVE CKD SERVICES INC
Other - Org Name:CKD SERVICES OF MONTGOMERY BAPTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, 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:781-699-2668
Mailing Address - Street 1:920 WINTER ST
Mailing Address - Street 2:FMCNA CKD SERVICES 3W-16
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1521
Mailing Address - Country:US
Mailing Address - Phone:781-699-4160
Mailing Address - Fax:781-699-4046
Practice Address - Street 1:1400 NARROW LANE PKWY
Practice Address - Street 2:CKD SERVICES OF MONTGOMERY BAPTIST
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2654
Practice Address - Country:US
Practice Address - Phone:334-286-4011
Practice Address - Fax:334-286-4108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-18
Last Update Date:2008-10-28
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
AL510G700385Medicare UPIN