Provider Demographics
NPI:1922422112
Name:FRESENIUS MEDICAL CARE DIALYSIS SERVICES - OREGON, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE DIALYSIS SERVICES - OREGON, LLC
Other - Org Name:FRESENIUS MEDICAL CARE EMERALD VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:350 Q ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2140
Mailing Address - Country:US
Mailing Address - Phone:541-747-4061
Mailing Address - Fax:541-747-4092
Practice Address - Street 1:350 Q ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2140
Practice Address - Country:US
Practice Address - Phone:541-747-4061
Practice Address - Fax:541-747-4092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-10
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR382574OtherPTAN