Basic Information
| Provider Information | |||||||||
| NPI: | 1417108754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESENIUS MEDICAL CARE OAHU LLC | ||||||||
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| OtherOrganizationName: | FRESENIUS MEDICAL CARE WINDWARD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45-480 KANEOHE BAY DR | ||||||||
| Address2: | #D09 | ||||||||
| City: | KANEOHE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967442039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082350885 | ||||||||
| FaxNumber: | 8082351955 | ||||||||
| Practice Location | |||||||||
| Address1: | 45-480 KANEOHE BAY DR | ||||||||
| Address2: | #D09 | ||||||||
| City: | KANEOHE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967442039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082350885 | ||||||||
| FaxNumber: | 8082351955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2008 | ||||||||
| LastUpdateDate: | 10/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | FAWCETT | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | 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.