1154742674 NPI number — RENAL CARE GROUP SOUTHWEST HOLDINGS, INC.

Table of content: (NPI 1154742674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154742674 NPI number — RENAL CARE GROUP SOUTHWEST HOLDINGS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAL CARE GROUP SOUTHWEST HOLDINGS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154742674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
745 S RIO VISTA DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85365-1729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-782-3815
Provider Business Mailing Address Fax Number:
928-782-8007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
745 S RIO VISTA DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85365-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-782-3815
Provider Business Practice Location Address Fax Number:
928-782-8007
Provider Enumeration Date:
12/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FAWCETT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
VP AND TREASURER
Authorized Official Telephone Number:
781-699-9000

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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