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NPI Code Detail

MEDICARE: FMS CABELL HUNTINGTON DIALYSIS CENTERS, LLC

MEDICARE: FMS CABELL HUNTINGTON DIALYSIS CENTERS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1164755823
Entity Type Code : Organization
Provider Name (Legal Business Name) : FMS CABELL HUNTINGTON DIALYSIS CENTERS, LLC
Provider Business Mailing Address
First Line : 517 3RD AVE
Second Line :
City : CHESAPEAKE
State : OH
Zip : 45619-1036
Country : US
Telephone Number : 740-867-4471
Fax Number : 740-867-4641
Provider Business Practice Location Address
First Line : 517 3RD AVE
Second Line :
City : CHESAPEAKE
State : OH
Zip : 45619-1036
Country : US
Telephone Number : 740-867-4471
Fax Number : 740-867-4641
Authorized Official
Title or Position : TREASURER
Name : MARK FAWCETT
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 09/14/2009
Last Update Date : 09/14/2009

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