Healthcare Provider Details

I. General information

NPI: 1053066019
Provider Name (Legal Business Name): FRESENIUS MEDICAL CARE CENTRAL FORT WORTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 ALSTON AVE
FT WORTH TX
76104-4506
US

IV. Provider business mailing address

1210 ALSTON AVE
FT WORTH TX
76104-4506
US

V. Phone/Fax

Practice location:
  • Phone: 817-338-1302
  • Fax: 817-338-0331
Mailing address:
  • Phone: 817-338-1302
  • Fax: 817-338-0331

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: SVP
Credential:
Phone: 781-699-9000