Provider Demographics
NPI:1346764156
Name:FRESENIUS KIDNEY CARE CONCHO VALLEY, LLC
Entity type:Organization
Organization Name:FRESENIUS KIDNEY CARE CONCHO VALLEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:2008 NINE RD
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:TX
Mailing Address - Zip Code:76825-7210
Mailing Address - Country:US
Mailing Address - Phone:325-659-7231
Mailing Address - Fax:325-792-3993
Practice Address - Street 1:2008 NINE RD
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-7210
Practice Address - Country:US
Practice Address - Phone:325-659-7231
Practice Address - Fax:325-792-3993
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment