Provider Demographics
NPI:1508807231
Name:RENAL CARE GROUP LAS VEGAS, LLC
Entity Type:Organization
Organization Name:RENAL CARE GROUP LAS VEGAS, LLC
Other - Org Name:FRESENIUS KIDNEY CARE NEVADA FIRE MESA
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 1:2450 FIRE MESA ST STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9032
Mailing Address - Country:US
Mailing Address - Phone:702-384-2242
Mailing Address - Fax:702-384-2262
Practice Address - Street 1:2450 FIRE MESA ST STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9032
Practice Address - Country:US
Practice Address - Phone:702-384-2242
Practice Address - Fax:702-384-2262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2023-10-23
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
NV292527Medicare Oscar/Certification