MEDICARE: FRESENIUS MEDICAL CARE COLUMBIA SQUARE, 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	:	1487121893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESENIUS MEDICAL CARE COLUMBIA SQUARE, LLC

Provider Business Mailing Address
First Line	:	1711 COLUMBIA SQ
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-2417
Country	:	US
Telephone Number	:	210-455-8836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 COLUMBIA SQ
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-2417
Country	:	US
Telephone Number	:	210-455-8836
Fax Number	:

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	12/01/2021

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