MEDICARE: FRESENIUS MEDICAL CARE OAHU 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	:	1417108754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESENIUS MEDICAL CARE OAHU LLC

Provider Business Mailing Address
First Line	:	45-480 KANEOHE BAY DR
Second Line	:	#D09
City	:	KANEOHE
State	:	HI
Zip	:	96744-2039
Country	:	US
Telephone Number	:	808-235-0885
Fax Number	:	808-235-1955

Provider Business Practice Location Address
First Line	:	45-480 KANEOHE BAY DR
Second Line	:	#D09
City	:	KANEOHE
State	:	HI
Zip	:	96744-2039
Country	:	US
Telephone Number	:	808-235-0885
Fax Number	:	808-235-1955

Authorized Official
Title or Position	:	TREASURER
Name	:	MARK FAWCETT
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	10/06/2008

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