1003383902 NPI number — FRESENIUS MEDICAL CARE CORPUS CHRISTI BAYSIDE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003383902 NPI number — FRESENIUS MEDICAL CARE CORPUS CHRISTI BAYSIDE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRESENIUS MEDICAL CARE CORPUS CHRISTI BAYSIDE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRESENIUS KIDNEY CARE CORPUS CHRISTI BAYSIDE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003383902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1121 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78404-2311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-884-8254
Provider Business Mailing Address Fax Number:
361-884-8529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78404-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-884-8254
Provider Business Practice Location Address Fax Number:
361-884-8529
Provider Enumeration Date:
10/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BLANTON
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
781-699-9000

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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