Healthcare Provider Details

I. General information

NPI: 1649567629
Provider Name (Legal Business Name): FMS MIDWEST DIALYSIS CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 N KLEIN CIR
DERBY KS
67037-7015
US

IV. Provider business mailing address

712 N KLEIN CIR
DERBY KS
67037-7015
US

V. Phone/Fax

Practice location:
  • Phone: 316-788-1434
  • Fax: 316-789-1439
Mailing address:
  • Phone: 316-788-1434
  • Fax: 316-789-1439

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: VP
Credential:
Phone: 781-699-9000