Healthcare Provider Details

I. General information

NPI: 1285031963
Provider Name (Legal Business Name): FRESENIUS VASCULAR CARE PENSACOLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 CREIGHTON RD STE 2
PENSACOLA FL
32504-7152
US

IV. Provider business mailing address

PO BOX 419076
BOSTON MA
02241-9076
US

V. Phone/Fax

Practice location:
  • Phone: 850-466-3843
  • Fax: 850-484-3106
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGG MILLER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 717-515-4048