Provider Demographics
NPI:1902571854
Name:FRESENIUS MEDICAL CARE CENTRACARE DIALYSIS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE CENTRACARE DIALYSIS, LLC
Other - Org Name:FRESENIUS KIDNEY CARE CAMBRIDGE
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 1:520 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-2003
Mailing Address - Country:US
Mailing Address - Phone:763-691-1333
Mailing Address - Fax:
Practice Address - Street 1:520 11TH AVE SW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-2003
Practice Address - Country:US
Practice Address - Phone:763-691-1333
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