Provider Demographics
NPI:1740220128
Name:WASATCH ARTIFICIAL KIDNEY CENTER LLC
Entity Type:Organization
Organization Name:WASATCH ARTIFICIAL KIDNEY CENTER LLC
Other - Org Name:FRESENIUS KIDNEY CARE WASATCH
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 1:3702 S STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5096
Mailing Address - Country:US
Mailing Address - Phone:801-904-4407
Mailing Address - Fax:801-288-6901
Practice Address - Street 1:3702 S STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-5096
Practice Address - Country:US
Practice Address - Phone:801-904-4407
Practice Address - Fax:801-288-6901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2023-10-17
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
UT=========007Medicaid
UT=========007OtherSELECT HEALTH
UT=========007Medicaid