Provider Demographics
NPI:1811175904
Name:RELIANT RENAL CARE - WEST FLINT, LLC
Entity type:Organization
Organization Name:RELIANT RENAL CARE - WEST FLINT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESENT
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:781-699-7000
Mailing Address - Street 1:G4007 CORUNNA RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4526
Mailing Address - Country:US
Mailing Address - Phone:810-877-6582
Mailing Address - Fax:810-877-6653
Practice Address - Street 1:G4007 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4526
Practice Address - Country:US
Practice Address - Phone:810-877-6582
Practice Address - Fax:810-877-6653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-31
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI232644Medicare Oscar/Certification