Provider Demographics
NPI:1992213078
Name:FRESENIUS MEDICAL CARE S.E. FORT WORTH, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE S.E. FORT WORTH, LLC
Other - Org Name:FRESENIUS KIDNEY CARE SOUTHEAST FORT WORTH
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 1:3708 E ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-1701
Mailing Address - Country:US
Mailing Address - Phone:817-413-0070
Mailing Address - Fax:817-413-0071
Practice Address - Street 1:3708 E ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-1701
Practice Address - Country:US
Practice Address - Phone:817-413-0070
Practice Address - Fax:817-413-0071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-11
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment