Healthcare Provider Details

I. General information

NPI: 1245658145
Provider Name (Legal Business Name): FMS KENTWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 CALLENDER DR. SE
KENTWOOD MI
49508-8771
US

IV. Provider business mailing address

4300 CALLENDER DR. SE
KENTWOOD MI
49508-8771
US

V. Phone/Fax

Practice location:
  • Phone: 616-454-1051
  • Fax: 616-451-1061
Mailing address:
  • Phone: 616-454-1051
  • Fax: 616-451-1061

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 StateMI

VIII. Authorized Official

Name: MR. BARRY BLANTON
Title or Position: VP
Credential:
Phone: 781-699-9000