Provider Demographics
NPI:1518788462
Name:FRESENIUS MEDICAL CARE NORTHEAST PORTLAND, LLC
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE NORTHEAST PORTLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:2824 NE WASCO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1772
Mailing Address - Country:US
Mailing Address - Phone:503-493-8227
Mailing Address - Fax:503-493-8502
Practice Address - Street 1:2824 NE WASCO ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1772
Practice Address - Country:US
Practice Address - Phone:503-493-8227
Practice Address - Fax:503-493-8502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment