MEDICARE: FRESENIUS MEDICAL CARE MECHANICSBURG DIALYSIS, 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	:	1649945585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESENIUS MEDICAL CARE MECHANICSBURG DIALYSIS, LLC

Provider Business Mailing Address
First Line	:	120 S FILBERT ST
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-6593
Country	:	US
Telephone Number	:	717-790-6080
Fax Number	:	717-790-6081

Provider Business Practice Location Address
First Line	:	120 S FILBERT ST
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-6593
Country	:	US
Telephone Number	:	717-790-6080
Fax Number	:	717-790-6081

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

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	10/23/2023

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