Basic Information
| Provider Information | |||||||||
| NPI: | 1720451438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESENIUS VASCULAR CARE PETERSBURG LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 VALLEY STREAM PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MALVERN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193551407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106448900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 CHARLES H DIMMOCK PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COLONIAL HEIGHTS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238342970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045262714 | ||||||||
| FaxNumber: | 8045262719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2015 | ||||||||
| LastUpdateDate: | 11/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | SNODGRASS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6106448900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.