Provider Demographics
NPI:1790090678
Name:RSA - TUMON, LLC
Entity Type:Organization
Organization Name:RSA - TUMON, LLC
Other - Org Name:U.S. RENAL CARE TUMON DIALYSIS
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 1:1406 N MARINE CORPS DR STE A
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4310
Mailing Address - Country:US
Mailing Address - Phone:671-646-3773
Mailing Address - Fax:671-647-2026
Practice Address - Street 1:1406 N MARINE CORPS DR STE A
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4310
Practice Address - Country:US
Practice Address - Phone:671-646-3773
Practice Address - Fax:671-647-2026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-16
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU583Medicaid
GU583Medicaid