| Entity Name: | FRESENIUS MEDICAL CARE FOUR CORNERS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Jun 2018 (7 years ago) |
| Document Number: | M18000005713 |
| FEI/EIN Number | 830910011 |
| Address: | 920 WINTER ST, WALTHAM, MA, 02451, US |
| Mail Address: | 920 WINTER ST, WALTHAM, MA, 02451, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477017515 | 2019-01-23 | 2024-09-25 | 503 CAGAN VIEW RD STE 300, CLERMONT, FL, 347146468, US | 503 CAGAN VIEW RD STE 300, CLERMONT, FL, 347146468, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 352-394-3003 |
| Fax | 3522432350 |
Authorized person
| Name | BARRY L. BLANTON |
| Role | VICE PRESIDENT |
| Phone | 7816999000 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 104452300 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role |
|---|---|
| BIO-MEDICAL APPLICATIONS OF FLORIDA, INC. | Member |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-09 |
| ANNUAL REPORT | 2023-02-23 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-07-22 |
| ANNUAL REPORT | 2019-04-25 |
| Foreign Limited | 2018-06-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
