Provider Demographics
NPI:1386180859
Name:RENAL CARE GROUP NORTHWEST, INC.
Entity Type:Organization
Organization Name:RENAL CARE GROUP NORTHWEST, INC.
Other - Org Name:FRESENIUS KIDNEY CARE MT. RAINIER
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 1:1115 REGENTS BLVD
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6031
Mailing Address - Country:US
Mailing Address - Phone:253-289-8303
Mailing Address - Fax:253-209-4844
Practice Address - Street 1:1115 REGENTS BLVD
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6031
Practice Address - Country:US
Practice Address - Phone:253-289-8303
Practice Address - Fax:253-209-4844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-09
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPTANOther50-2591
WA502307Medicare Oscar/Certification