Healthcare Provider Details

I. General information

NPI: 1992386635
Provider Name (Legal Business Name): FMS OWOSSO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 10/24/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HEALTH PARK DR
OWOSSO MI
48867-1200
US

IV. Provider business mailing address

500 HEALTH PARK DR
OWOSSO MI
48867-1200
US

V. Phone/Fax

Practice location:
  • Phone: 989-725-1041
  • Fax: 989-725-1061
Mailing address:
  • Phone: 989-725-1041
  • Fax: 989-725-1061

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 State

VIII. Authorized Official

Name: JAMES JOSEPH DIVITO
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-699-9172