Healthcare Provider Details

I. General information

NPI: 1891890174
Provider Name (Legal Business Name): FMS PHILADELPHIA DIALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/24/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 FOX ST STE C
PHILADELPHIA PA
19129-1230
US

IV. Provider business mailing address

3401 FOX ST STE C
PHILADELPHIA PA
19129-1230
US

V. Phone/Fax

Practice location:
  • Phone: 215-221-3120
  • Fax: 215-227-4295
Mailing address:
  • Phone: 215-221-3120
  • Fax: 215-227-4295

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