Provider Demographics
NPI:1790897692
Name:PACIFIC NORTHWEST RENAL SERVICES, L.L.C.
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST RENAL SERVICES, L.L.C.
Other - Org Name:FRESENIUS KIDNEY CARE FORT VANCOUVER
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 1:13118 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5809
Mailing Address - Country:US
Mailing Address - Phone:360-254-2323
Mailing Address - Fax:360-254-8289
Practice Address - Street 1:13118 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5809
Practice Address - Country:US
Practice Address - Phone:360-254-2323
Practice Address - Fax:360-254-8289
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
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
WA50-2522OtherPTAN
WA502522Medicare Oscar/Certification