Provider Demographics
NPI:1972594059
Name:RENAL CARE CONSULTANTS PC
Entity type:Organization
Organization Name:RENAL CARE CONSULTANTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:541-776-4805
Mailing Address - Street 1:2868 CREEKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8442
Mailing Address - Country:US
Mailing Address - Phone:541-776-4805
Mailing Address - Fax:541-773-6016
Practice Address - Street 1:2868 CREEKSIDE CIR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8442
Practice Address - Country:US
Practice Address - Phone:541-776-4805
Practice Address - Fax:541-773-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXCDC00693OtherMEDI CAL
OR208390Medicaid
OR208390Medicaid