Provider Demographics
NPI:1588142814
Name:FRESENIUS MEDICAL CARE SOUTHERN MARYLAND HOME, LLC
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE SOUTHERN MARYLAND HOME, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:28103 THREE NOTCH RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-3294
Mailing Address - Country:US
Mailing Address - Phone:301-884-6052
Mailing Address - Fax:301-884-6054
Practice Address - Street 1:28103 THREE NOTCH RD STE 1A
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3294
Practice Address - Country:US
Practice Address - Phone:301-884-6052
Practice Address - Fax:301-884-6054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-30
Last Update Date:2023-10-20
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
MD460022301Medicaid