Provider Demographics
NPI:1972522142
Name:FRESENIUS MEDICAL CARE OF O'FALLON
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE OF O'FALLON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MATTLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:636-300-4036
Mailing Address - Street 1:4663 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8690
Mailing Address - Country:US
Mailing Address - Phone:636-300-4036
Mailing Address - Fax:636-300-4065
Practice Address - Street 1:4663 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8690
Practice Address - Country:US
Practice Address - Phone:636-300-4036
Practice Address - Fax:636-300-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment