Basic Information
| Provider Information | |||||||||
| NPI: | 1083259634 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESENIUS MEDICAL CARE COLORADO SPRINGS, LLC | ||||||||
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| OtherOrganizationName: | LIBERTY DIALYSIS - COLORADO SPRINGS WEST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3326 CENTENNIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809074092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192576867 | ||||||||
| FaxNumber: | 7192576870 | ||||||||
| Practice Location | |||||||||
| Address1: | 3326 CENTENNIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809074092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192576867 | ||||||||
| FaxNumber: | 7192576870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2019 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | BLANTON | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7816999000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FRESENIUS MEDICAL CARE HOLDINGS, INC. | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.