Provider Demographics
NPI:1750483921
Name:RENAL CARE GROUP ARIZONA, LLC
Entity Type:Organization
Organization Name:RENAL CARE GROUP ARIZONA, LLC
Other - Org Name:RENAL CARE GROUP NATIVE AMERICAN
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:BOX 207
Mailing Address - Street 2:SEED FARM & SKILL CENTER ROAD
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85247-0207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SEED FARM & SKILL CENTER ROAD
Practice Address - Street 2:BOX 207
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85247-0207
Practice Address - Country:US
Practice Address - Phone:520-562-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-01
Last Update Date:2008-10-17
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
032532Medicare Oscar/Certification