MEDICARE: RCG INDIANA, 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	:	1417062266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RCG INDIANA, LLC

Provider Business Mailing Address
First Line	:	6635 E 21ST ST
Second Line	:	SUITE 400
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2254
Country	:	US
Telephone Number	:	317-353-8900
Fax Number	:	317-351-2410

Provider Business Practice Location Address
First Line	:	6635 E 21ST ST
Second Line	:	SUITE 400
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2254
Country	:	US
Telephone Number	:	317-353-8900
Fax Number	:	317-351-2410

Authorized Official
Title or Position	:	TREASURER
Name	:	MARK FAWCETT
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/17/2009

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Directions to “RCG INDIANA, LLC ” Practice Location

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