Provider Demographics
NPI:1235244088
Name:RCG INDIANA, L.L.C.
Entity Type:Organization
Organization Name:RCG INDIANA, L.L.C.
Other - Org Name:FRESENIUS MEDICAL CARE FORT WAYNE JEFFERSON
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 1:7836 W JEFFERSON BLVD STE LL10
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4165
Mailing Address - Country:US
Mailing Address - Phone:260-432-4225
Mailing Address - Fax:260-432-6247
Practice Address - Street 1:7836 W JEFFERSON BLVD STE LL10
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4165
Practice Address - Country:US
Practice Address - Phone:260-432-4225
Practice Address - Fax:260-432-6247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2023-10-16
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
152515Medicare Oscar/Certification