Provider Demographics
NPI:1851543219
Name:FRESENIUS MEDICAL CARE GOOCHLAND NEPHROLOGY, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE GOOCHLAND NEPHROLOGY, LLC
Other - Org Name:FRESENIUS MEDICAL CARE GOOCHLAND
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 1:2913 RIVER RD W STE K
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-3263
Mailing Address - Country:US
Mailing Address - Phone:804-556-5130
Mailing Address - Fax:804-556-5131
Practice Address - Street 1:2913 RIVER RD W STE K
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3263
Practice Address - Country:US
Practice Address - Phone:804-556-5130
Practice Address - Fax:804-556-5131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-16
Last Update Date:2021-08-30
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
492657Medicare Oscar/Certification