MEDICARE: FRESENIUS MEDICAL CARE SAN BERNARDINO, 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

General Provider Information

NPI Number	:	1174386866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESENIUS MEDICAL CARE SAN BERNARDINO, LLC

Provider Business Mailing Address
First Line	:	952 S MOUNT VERNON AVE STE C
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-4224
Country	:	US
Telephone Number	:	909-804-3138
Fax Number	:	909-424-9791

Provider Business Practice Location Address
First Line	:	952 S MOUNT VERNON AVE STE C
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-4224
Country	:	US
Telephone Number	:	909-804-3138
Fax Number	:	909-424-9791

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

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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