Provider Demographics
NPI:1366513954
Name:FRESENIUS MEDICAL CARE
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-825-2046
Mailing Address - Street 1:7170 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1849
Mailing Address - Country:US
Mailing Address - Phone:305-825-2046
Mailing Address - Fax:305-822-2244
Practice Address - Street 1:7170 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1849
Practice Address - Country:US
Practice Address - Phone:305-825-2046
Practice Address - Fax:305-822-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102530Medicare ID - Type Unspecified