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	:	1588779334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RCG INDIANA LLC

Provider Business Mailing Address
First Line	:	1740 INDUSTRY DR
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2737
Country	:	US
Telephone Number	:	317-353-8207
Fax Number	:	317-353-8211

Provider Business Practice Location Address
First Line	:	1740 INDUSTRY DR
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2737
Country	:	US
Telephone Number	:	317-353-8207
Fax Number	:	317-353-8211

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	10/16/2015

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