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NPI Code Detail

MEDICARE: RCG BLOOMINGTON, LLC

MEDICARE: RCG BLOOMINGTON, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1215042064
Entity Type Code : Organization
Provider Name (Legal Business Name) : RCG BLOOMINGTON, LLC
Provider Business Mailing Address
First Line : 11 N CRANE AVE
Second Line :
City : SPENCER
State : IN
Zip : 47460-1507
Country : US
Telephone Number : 812-829-3385
Fax Number : 812-829-3386
Provider Business Practice Location Address
First Line : 11 N CRANE AVE
Second Line :
City : SPENCER
State : IN
Zip : 47460-1507
Country : US
Telephone Number : 812-829-3385
Fax Number : 812-829-3386
Authorized Official
Title or Position : VICE PRESIDENT
Name : BARRY L. BLANTON
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 08/20/2006
Last Update Date : 10/16/2023

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Directions to “RCG BLOOMINGTON, LLC ” Practice Location

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