MEDICARE: FRESENIUS MEDICAL CARE FORT WAYNE, 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	:	1457772410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESENIUS MEDICAL CARE FORT WAYNE, LLC

Provider Business Mailing Address
First Line	:	3334 LAKE CITY HWY
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3923
Country	:	US
Telephone Number	:	574-269-3553
Fax Number	:	574-269-6814

Provider Business Practice Location Address
First Line	:	3334 LAKE CITY HWY
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3923
Country	:	US
Telephone Number	:	574-269-3553
Fax Number	:	574-269-6814

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

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	10/17/2023

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