Healthcare Provider Details

I. General information

NPI: 1609152792
Provider Name (Legal Business Name): FMS MIDWEST DIALYSIS CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W 15TH AVE STE E
EMPORIA KS
66801-9804
US

IV. Provider business mailing address

1602 W 15TH AVE STE E
EMPORIA KS
66801-9804
US

V. Phone/Fax

Practice location:
  • Phone: 620-340-0034
  • Fax: 620-343-2259
Mailing address:
  • Phone: 620-340-0034
  • Fax: 620-343-2259

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