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NPI Code Detail

MEDICARE: RCG MISSISSIPPI, INC.

MEDICARE: RCG MISSISSIPPI, INC.
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 : 1306958178
Entity Type Code : Organization
Provider Name (Legal Business Name) : RCG MISSISSIPPI, INC.
Provider Business Mailing Address
First Line : 2010 N STATE ST
Second Line :
City : CLARKSDALE
State : MS
Zip : 38614-6100
Country : US
Telephone Number : 662-627-4786
Fax Number : 662-624-4173
Provider Business Practice Location Address
First Line : 2010 N STATE ST
Second Line :
City : CLARKSDALE
State : MS
Zip : 38614-6100
Country : US
Telephone Number : 662-627-4786
Fax Number : 662-624-4173
Authorized Official
Title or Position : VICE PRESIDENT
Name : BARRY L. BLANTON
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 08/31/2006
Last Update Date : 10/16/2023

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Directions to “RCG MISSISSIPPI, INC. ” Practice Location

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