Healthcare Provider Details

I. General information

NPI: 1760151682
Provider Name (Legal Business Name): FRESENIUS VASCULAR CARE PENSACOLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E REDSTONE AVE
CRESTVIEW FL
32539-5373
US

IV. Provider business mailing address

PO BOX 419076
BOSTON MA
02241-9076
US

V. Phone/Fax

Practice location:
  • Phone: 850-398-6606
  • Fax:
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGG ARTHUR MILLER
Title or Position: SR. VICE PRESIDENT
Credential: MD
Phone: 610-644-8900