Provider Demographics
NPI:1912128422
Name:RCG INDIANA LLC
Entity Type:Organization
Organization Name:RCG INDIANA LLC
Other - Org Name:FRESENIUS MEDICAL CARE FORT DEKALB COUNTY DIALYSIS
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 1:1144 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2096
Mailing Address - Country:US
Mailing Address - Phone:260-927-1309
Mailing Address - Fax:206-927-1322
Practice Address - Street 1:1144 W 15TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2096
Practice Address - Country:US
Practice Address - Phone:260-927-1309
Practice Address - Fax:206-927-1322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-01
Last Update Date:2012-10-31
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
152550Medicare Oscar/Certification