Provider Demographics
NPI:1073625810
Name:RCG PENSACOLA, LLC
Entity Type:Organization
Organization Name:RCG PENSACOLA, LLC
Other - Org Name:RENAL CARE GROUP DESTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:7720 US HIGHWAY 98 W STE 150
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7235
Mailing Address - Country:US
Mailing Address - Phone:850-622-9717
Mailing Address - Fax:850-622-1935
Practice Address - Street 1:7720 US HIGHWAY 98 W STE 150
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7235
Practice Address - Country:US
Practice Address - Phone:850-622-9717
Practice Address - Fax:850-622-1935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102804Medicare Oscar/Certification