MEDICARE: FRESENIUS MEDICAL CARE SOUTHWEST FORT WORTH, 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1780314690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESENIUS MEDICAL CARE SOUTHWEST FORT WORTH, LLC

Provider Business Mailing Address
First Line	:	4804 BRYANT IRVIN CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7640
Country	:	US
Telephone Number	:	817-738-8703
Fax Number	:	817-732-6126

Provider Business Practice Location Address
First Line	:	4804 BRYANT IRVIN CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7640
Country	:	US
Telephone Number	:	817-738-8703
Fax Number	:	817-732-6126

Authorized Official
Title or Position	:	VP
Name	:	BARRY BLANTON
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	10/24/2023

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