Healthcare Provider Details

I. General information

NPI: 1497498976
Provider Name (Legal Business Name): FMS BEAUMONT HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E 13 MILE RD
ROYAL OAK MI
48073-2868
US

IV. Provider business mailing address

595 E 13 MILE RD
ROYAL OAK MI
48073-2868
US

V. Phone/Fax

Practice location:
  • Phone: 781-699-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 BLANTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 214-445-3010