Provider Demographics
NPI:1841736329
Name:RENAL CARE GROUP NORTHWEST, INC.
Entity Type:Organization
Organization Name:RENAL CARE GROUP NORTHWEST, INC.
Other - Org Name:FRESENIUS KIDNEY CARE SOUTH TACOMA
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 1:5825 TACOMA MALL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6906
Mailing Address - Country:US
Mailing Address - Phone:253-671-9937
Mailing Address - Fax:253-671-9954
Practice Address - Street 1:5825 TACOMA MALL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6906
Practice Address - Country:US
Practice Address - Phone:253-671-9937
Practice Address - Fax:253-671-9954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-09
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50-2590OtherMEDICARE OSCAR/CERTIFICATION