Provider Demographics
NPI:1871761130
Name:FRESNIUS MEDICAL CARE COMPREHENSIVE CKD SERVIES INC
Entity type:Organization
Organization Name:FRESNIUS MEDICAL CARE COMPREHENSIVE CKD SERVIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-2668
Mailing Address - Street 1:920 WINTER ST
Mailing Address - Street 2:FMCNA CKD SERVICES 3W-16
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1521
Mailing Address - Country:US
Mailing Address - Phone:781-699-4160
Mailing Address - Fax:781-699-4046
Practice Address - Street 1:1520 FREEDOM BLVD
Practice Address - Street 2:CKD SERVICES OF FREEDOM
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6040
Practice Address - Country:US
Practice Address - Phone:843-292-8440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment