Healthcare Provider Details

I. General information

NPI: 1417948340
Provider Name (Legal Business Name): RENAL CARE CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2868 CREEKSIDE CIR
MEDFORD OR
97504-8442
US

IV. Provider business mailing address

201 SW L ST
GRANTS PASS OR
97526-2913
US

V. Phone/Fax

Practice location:
  • Phone: 541-776-4805
  • Fax: 541-773-6016
Mailing address:
  • Phone: 541-474-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number State

VIII. Authorized Official

Name: KAREN MCEWEN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 541-776-4805