Provider Demographics
NPI:1518079490
Name:RENAL CARE GROUP TEXAS INC
Entity Type:Organization
Organization Name:RENAL CARE GROUP TEXAS INC
Other - Org Name:CROCKETT DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:2001 E BOWIE AVE
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-3313
Mailing Address - Country:US
Mailing Address - Phone:936-546-0849
Mailing Address - Fax:936-546-8355
Practice Address - Street 1:2001 E BOWIE AVE
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-3313
Practice Address - Country:US
Practice Address - Phone:936-546-0849
Practice Address - Fax:936-546-8355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
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
TX452768Medicare Oscar/Certification