MEDICARE: FRESENIUS MEDICAL CARE COMPREHENSIVE CKD SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1043488695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESENIUS MEDICAL CARE COMPREHENSIVE CKD SERVICES INC

Provider Business Mailing Address
First Line	:	920 WINTER ST
Second Line	:	FMCNA CKD SERVICES 3W-16
City	:	WALTHAM
State	:	MA
Zip	:	02451-1521
Country	:	US
Telephone Number	:	781-699-4160
Fax Number	:	781-699-4046

Provider Business Practice Location Address
First Line	:	1680 SE LYNGATE DR
Second Line	:	STE. 101 CKD SERVICES OF PT. ST. LUCIE
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-4300
Country	:	US
Telephone Number	:	772-335-2407
Fax Number	:	772-335-8509

Authorized Official
Title or Position	:	VICE PRESIDENT, TREASURER
Name	:	MARK FAWCETT
Credential	:
Telephone Number	:	781-699-2668

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	10/21/2008

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