Provider Demographics
NPI:1063703841
Name:FRESENIUS MEDICAL CARE SOUTHERN DELAWARE, LLC
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE SOUTHERN DELAWARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:23006 SUSSEX HWY
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-5866
Mailing Address - Country:US
Mailing Address - Phone:302-628-3152
Mailing Address - Fax:302-628-1589
Practice Address - Street 1:23006 SUSSEX HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-5866
Practice Address - Country:US
Practice Address - Phone:302-628-3152
Practice Address - Fax:302-628-1589
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
082508Medicare Oscar/Certification