MEDICARE: RENAL CARE GROUP OF THE MIDWEST, 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1932214756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAL CARE GROUP OF THE MIDWEST, INC.

Provider Business Mailing Address
First Line	:	204 W ROSS BLVD
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2133
Country	:	US
Telephone Number	:	620-225-7100
Fax Number	:	620-225-7362

Provider Business Practice Location Address
First Line	:	204 W ROSS BLVD
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2133
Country	:	US
Telephone Number	:	620-225-7100
Fax Number	:	620-225-7362

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	11/09/2010

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