Provider Demographics
NPI:1477665347
Name:RENAL CARE GROUP OF THE MIDWEST
Entity Type:Organization
Organization Name:RENAL CARE GROUP OF THE MIDWEST
Other - Org Name:RENAL CARE GROUP ENID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN. ASST.
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-733-1891
Mailing Address - Street 1:121 W OWEN K GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 W OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5617
Practice Address - Country:US
Practice Address - Phone:580-233-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAL CARE GROUP OF THE MIDWEST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2008-07-30
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
372558Medicare Oscar/Certification