Provider Demographics
NPI:1972278810
Name:FRESENIUS MEDICAL CARE CENTRACARE DIALYSIS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE CENTRACARE DIALYSIS, LLC
Other - Org Name:FRESENIUS KIDNEY CARE BIG LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
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 1:16830 198TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-4860
Mailing Address - Country:US
Mailing Address - Phone:763-263-7320
Mailing Address - Fax:
Practice Address - Street 1:16830 198TH AVE NW
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-4860
Practice Address - Country:US
Practice Address - Phone:763-263-7320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-12
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