Provider Demographics
NPI:1992386635
Name:FMS OWOSSO, LLC
Entity Type:Organization
Organization Name:FMS OWOSSO, LLC
Other - Org Name:OWOSSO MEMORIAL DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DIVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9172
Mailing Address - Street 1:500 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1200
Mailing Address - Country:US
Mailing Address - Phone:989-725-1041
Mailing Address - Fax:989-725-1061
Practice Address - Street 1:500 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1200
Practice Address - Country:US
Practice Address - Phone:989-725-1041
Practice Address - Fax:989-725-1061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment