MEDICARE: FRESENIUS MEDICAL CARE CENTRAL FORT WORTH, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

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

Provider Business Mailing Address
First Line	:	1210 ALSTON AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-4506
Country	:	US
Telephone Number	:	817-338-1302
Fax Number	:	817-338-0331

Provider Business Practice Location Address
First Line	:	1210 ALSTON AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-4506
Country	:	US
Telephone Number	:	817-338-1302
Fax Number	:	817-338-0331

Authorized Official
Title or Position	:	SVP
Name	:	BARRY L BLANTON
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	02/18/2022
Last Update Date	:	11/06/2024

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