Provider Demographics
NPI:1528665643
Name:FRESENIUS MEDICAL CARE PAYSON, LLC
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE PAYSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:50 S. MAIN STREET
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045
Mailing Address - Country:US
Mailing Address - Phone:928-851-6220
Mailing Address - Fax:928-225-3388
Practice Address - Street 1:50 S. MAIN STREET
Practice Address - Street 2:SUITE 108
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:928-851-6220
Practice Address - Fax:928-225-3388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment