Provider Demographics
NPI:1629184569
Name:RENAL CARE GROUP OF THE MIDWEST, INC.
Entity Type:Organization
Organization Name:RENAL CARE GROUP OF THE MIDWEST, INC.
Other - Org Name:FRESENIUS MEDICAL CARE WICHITA WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:750 N SOCORA ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3795
Mailing Address - Country:US
Mailing Address - Phone:316-729-5321
Mailing Address - Fax:316-729-5326
Practice Address - Street 1:750 N SOCORA ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3795
Practice Address - Country:US
Practice Address - Phone:316-729-5321
Practice Address - Fax:316-729-5326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-22
Last Update Date:2011-04-22
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
KS172540Medicare Oscar/Certification