Provider Demographics
NPI:1295840015
Name:RENAL CARE GROUP OF THE MIDWEST, INC.
Entity Type:Organization
Organization Name:RENAL CARE GROUP OF THE MIDWEST, INC.
Other - Org Name:RENAL CARE GROUP ARKANSAS CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-402-9000
Mailing Address - Street 1:216 W BIRCH AVE
Mailing Address - Street 2:STH CEN KANSAS REGIONAL MED CTR
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-1563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 W BIRCH AVE
Practice Address - Street 2:STH CEN KANSAS REGIONAL MED CTR
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-1563
Practice Address - Country:US
Practice Address - Phone:620-441-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
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
172525Medicare ID - Type Unspecified