FMS CLYDE PARK SOUTH, LLC (NPI# 1245509348) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245509348 |
| Entity Type | Organization |
| Organization Name | FMS CLYDE PARK SOUTH, LLC |
| Other Organization Name | FRESENIUS KIDNEY CARE CLYDE PARK SOUTH |
| Practice Address |
5311 Clyde Park Ave Sw Grand Rapids MI 49509 |
| Mailing Address |
5311 Clyde Park Ave Sw Grand Rapids MI 49509-9527 |
| Practice Telephone | 6165347179 |
| Practice Fax Number | 6165347930 |
| Mailing Telephone | 6165347179 |
| Mailing Fax Number | 6165347930 |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2019-01-11 |
| Authorized Official Name | MARK FAWCETT (SR. VP AND TREASURER) |
| Authorized Official Telephone | 7816999000 |
| Is Organization Subpart | Y |
| Parent Organization Name | FRESENIUS MEDICAL CARE HOLDINGS, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Fresenius Kidney Care Clyde Park South | Doing Business As Name - Organization |
| Fresenius Medical Care Kent County | Doing Business As Name - Organization |
| Street Address |
5311 CLYDE PARK AVE SW |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023620713 | Lindsay Kayann Ottowitz | Behavior Technician | 1428 44th St. Sw, Wyoming, MI 49509 | 2020-08-23 |
| 1750990016 | Lindsay Alexandra Lyszczarz | Behavior Technician | 5281 Clyde Park Ave Se, Suite 2, Wyoming, MI 49509 | 2020-07-23 |
| 1033690409 | Courtney M Garner | Behavior Technician | 1428 44th Street, Wyoming, MI 49509 | 2018-08-23 |
| 1457857195 | Ashley Mae Autio | Case Manager/Care Coordinator | 795 36th Street, Wyoming, MI 49509 | 2018-04-02 |
| 1689124588 | Jacqeulyn Harmon | Behavioral Analyst | 2819 Peckheath Rd Sw Apt D, Wyoming, MI 49509 | 2016-10-04 |
| 1275988925 | Intsar Abdulahe | Social Worker | 1551 Charles Russell, Wyoming, MI 49509 | 2016-05-02 |
| 1992160071 | Concierge Home Care Services of West Michigan, LLC | Home Infusion | 1360 56th Street Sw, Wyoming, MI 49509 | 2015-12-16 |
| 1417349796 | Yashana Duncan | Case Manager/Care Coordinator | 225 Colrain St. Sw, Suite 2, Wyoming, MI 49509 | 2015-02-24 |
| 1710378377 | Rawm Vascular Access, Pllc | Internal Medicine | 1540 36th Street. Sw, Wyoming, MI 49509 | 2015-02-17 |
| 1366882755 | Kevin Timothy Solt | Dentist | 1535 44th St Sw Ste 200, Wyoming, MI 49509 | 2013-06-28 |
| Find all providers in zip 49509 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255840427 | Home Advantage Dialysis | Clinic/Center | 1621 44th St Sw Ste 300, Grand Rapids, MI 49509-4387 | 2017-09-20 |
| 1417333725 | Total Renal Care Inc | Clinic/Center | 705 28th St Se, Grand Rapids, MI 49548-1303 | 2015-08-10 |
| 1497860233 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 155 Se 13th St, Grand Rapids, MN 55744-4242 | 2006-08-20 |
| 1568424455 | Physicians Dialysis Acquisitions Inc | Clinic/Center | 1230 Ekhart St Ne, Grand Rapids, MI 49503-1372 | 2006-04-05 |
| 1508827023 | Physicians Dialysis Acquisitions Inc | Clinic/Center | 801 Cherry St Se, Grand Rapids, MI 49506-1440 | 2006-04-01 |
| 1124650130 | Spectrum Health Hospitals | Clinic/Center | 35 Michigan St Ne, Grand Rapids, MI 49503-2514 | 2020-02-07 |
| 1285072447 | Bowan Dialysis LLC | Clinic/Center | 330 E Beltline Ave Ne, Ste 2047, Grand Rapids, MI 49506-1267 | 2013-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497961 | Saint Marina Home Dialysis LLC | Clinic/Center | 26711 Northwestern Hwy Ste 125, Southfield, MI 48033-2170 | 2020-11-05 |
| 1144820226 | Heritage Home Dialysis LLC | Clinic/Center | 1580 N Leroy St Ste 6, Fenton, MI 48430-2801 | 2020-10-28 |
| 1386262350 | Delta Renal Care Pllc | Clinic/Center | 3981 Elizabeth Ave, Canton, MI 48188-7223 | 2020-07-07 |
| 1457973257 | Fms Owosso, LLC | Clinic/Center | 918 Corunna Ave, Owosso, MI 48867-3768 | 2020-05-14 |
| 1023650926 | Falmont Dialysis LLC | Clinic/Center | 37290 5 Mile Rd, Livonia, MI 48154-1848 | 2019-10-11 |
| 1487112942 | Michigan Dialysis Services, LLC | Clinic/Center | 275 N Canton Center Rd, Canton, MI 48187 | 2019-03-04 |
| 1487123600 | Concerto Michigan LLC | Clinic/Center | 14700 Farmington Rd Ste 108, Livonia, MI 48154-5462 | 2018-11-16 |
| 1245715291 | Brooksprings Dialysis, LLC | Clinic/Center | 2391 Fifteen Mile Rd, Sterling Heights, MI 48310 | 2018-09-26 |
| 1851886592 | Fms Rochester Hills, LLC | Clinic/Center | 26400 W 12 Mile Rd Ste 112, Southfield, MI 48034-1785 | 2018-06-26 |
| 1801399753 | Kasaskia Dialysis LLC | Clinic/Center | 18001 E 10 Mile Rd Ste B, Roseville, MI 48066-3803 | 2018-03-16 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49509 |
Please comment or provide details below to improve the information on FMS CLYDE PARK SOUTH, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.