Provider Demographics
NPI:1710511399
Name:FRESENIUS MEDICAL CARE OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE OF ILLINOIS, LLC
Other - Org Name:FRESENIUS KIDNEY CARE MADISON COUNTY
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 1:1946 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4613
Mailing Address - Country:US
Mailing Address - Phone:618-801-4845
Mailing Address - Fax:618-801-4850
Practice Address - Street 1:1946 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4613
Practice Address - Country:US
Practice Address - Phone:618-801-4845
Practice Address - Fax:618-801-4850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-24
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