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NPI Code Detail

MEDICARE: RCG INDIANA, L.L.C.

MEDICARE: RCG INDIANA, L.L.C.
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 : 1235244088
Entity Type Code : Organization
Provider Name (Legal Business Name) : RCG INDIANA, L.L.C.
Provider Business Mailing Address
First Line : 7836 W JEFFERSON BLVD STE LL10
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4165
Country : US
Telephone Number : 260-432-4225
Fax Number : 260-432-6247
Provider Business Practice Location Address
First Line : 7836 W JEFFERSON BLVD STE LL10
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4165
Country : US
Telephone Number : 260-432-4225
Fax Number : 260-432-6247
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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