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NPI Code Detail

MEDICARE: RENAL CARE GROUP NORTHWEST, INC.

MEDICARE: RENAL CARE GROUP NORTHWEST, 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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
150-2548OTHERPTAN

General Provider Information

NPI Number : 1083774483
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAL CARE GROUP NORTHWEST, INC.
Provider Business Mailing Address
First Line : 1872 N 13TH LOOP RD
Second Line :
City : SHELTON
State : WA
Zip : 98584-2169
Country : US
Telephone Number : 360-432-2601
Fax Number : 360-432-2608
Provider Business Practice Location Address
First Line : 1872 N 13TH LOOP RD
Second Line :
City : SHELTON
State : WA
Zip : 98584-2169
Country : US
Telephone Number : 360-432-2601
Fax Number : 360-432-2608
Authorized Official
Title or Position : VICE PRESIDENT
Name : BARRY L. BLANTON
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 12/08/2006
Last Update Date : 10/16/2023

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