Basic Information
| Provider Information | |||||||||
| NPI: | 1225582174 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESENIUS MEDICAL CARE CREIGHTON DIALYSIS, LLC | ||||||||
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| OtherOrganizationName: | FRESENIUS KIDNEY CARE CREIGHTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E MAIN CROSS ST | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458406317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235184 | ||||||||
| FaxNumber: | 4194235184 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E MAIN CROSS ST | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458406317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235184 | ||||||||
| FaxNumber: | 4194235184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2016 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | FAWCETT | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. VP AND TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 7816999000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FRESENIUS MEDICAL CARE HOLDINGS, INC. | ||||||||
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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.