Provider Demographics
NPI:1790371698
Name:FRESENIUS MEDICAL CARE SURF ROAD HOME DIALYSIS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE SURF ROAD HOME DIALYSIS, LLC
Other - Org Name:FRESENIUS KIDNEY CARE SURF ROAD HOME 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 1:2845 N SHERIDAN ROAD
Mailing Address - Street 2:SUITE 703
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7227
Mailing Address - Country:US
Mailing Address - Phone:312-605-1810
Mailing Address - Fax:872-895-9194
Practice Address - Street 1:2845 N SHERIDAN ROAD
Practice Address - Street 2:SUITE 703
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7227
Practice Address - Country:US
Practice Address - Phone:312-605-1810
Practice Address - Fax:872-895-9194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-15
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