MEDICARE: RELIANT RENAL CARE-COLORADO, 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1497759153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANT RENAL CARE-COLORADO, LLC

Provider Business Mailing Address
First Line	:	PO BOX 671661
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-1661
Country	:	US
Telephone Number	:	610-892-4700
Fax Number	:	610-892-9760

Provider Business Practice Location Address
First Line	:	1605 N UNION BLVD
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2811
Country	:	US
Telephone Number	:	719-447-0818
Fax Number	:	719-520-1506

Authorized Official
Title or Position	:	CEO
Name	:	MRS. BARBARA BEDNAR
Credential	:
Telephone Number	:	610-892-4700

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/17/2012

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