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NPI Code Detail

MEDICARE: FRESENIUS MEDICAL CARE MARKET STREET DIALYSIS, LLC

MEDICARE: FRESENIUS MEDICAL CARE MARKET STREET 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1679047518
Entity Type Code : Organization
Provider Name (Legal Business Name) : FRESENIUS MEDICAL CARE MARKET STREET DIALYSIS, LLC
Provider Business Mailing Address
First Line : 12098 EAST FWY
Second Line :
City : HOUSTON
State : TX
Zip : 77029-1916
Country : US
Telephone Number : 713-815-6867
Fax Number : 832-325-2945
Provider Business Practice Location Address
First Line : 12098 EAST FWY
Second Line :
City : HOUSTON
State : TX
Zip : 77029-1916
Country : US
Telephone Number : 713-815-6867
Fax Number : 832-325-2945
Authorized Official
Title or Position : VICE PRESIDENT
Name : BARRY L. BLANTON
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 01/14/2019
Last Update Date : 10/20/2023

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