Healthcare Provider Details

I. General information

NPI: 1699002766
Provider Name (Legal Business Name): FMS NEPHROLOGY PARTNERS NORTH CENTRAL INDIANA DIALYSIS CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 MONROE ST
LA PORTE IN
46350-5249
US

IV. Provider business mailing address

2910 MONROE ST
LA PORTE IN
46350-5249
US

V. Phone/Fax

Practice location:
  • Phone: 219-324-0944
  • Fax: 219-325-3015
Mailing address:
  • Phone: 219-324-0944
  • Fax: 219-325-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARRY L. BLANTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-699-9000