Provider Demographics
NPI:1952847428
Name:RENAL CARE GROUP NORTHWEST, INC.
Entity Type:Organization
Organization Name:RENAL CARE GROUP NORTHWEST, INC.
Other - Org Name:FRESENIUS KIDNEY CARE PUYALLUP
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 1:702 S HILL PARK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1426
Mailing Address - Country:US
Mailing Address - Phone:253-445-7520
Mailing Address - Fax:253-848-3068
Practice Address - Street 1:702 S HILL PARK DR STE 105
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1426
Practice Address - Country:US
Practice Address - Phone:253-445-7520
Practice Address - Fax:253-848-3068
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
WA50-2587OtherPTAN
WA50-2587OtherOSCAR
WA50-2587OtherOSCAR