Provider Demographics
NPI:1417062266
Name:RCG INDIANA, LLC
Entity Type:Organization
Organization Name:RCG INDIANA, LLC
Other - Org Name:FRESENIUS MEDICAL CARE INDIANAPOLIS EAST
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:781-699-9000
Mailing Address - Street 1:6635 E 21ST ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-2254
Mailing Address - Country:US
Mailing Address - Phone:317-353-8900
Mailing Address - Fax:317-351-2410
Practice Address - Street 1:6635 E 21ST ST
Practice Address - Street 2:SUITE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2254
Practice Address - Country:US
Practice Address - Phone:317-353-8900
Practice Address - Fax:317-351-2410
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:2009-07-17
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
152502Medicare Oscar/Certification