NPIMap

Organization Active NPI

Prescott Renal Care Group, LLC

Doing business as Renal Care Group Prescott

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Dewey, AZ
National Provider Identifier
1386756195
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
PRESCOTT RENAL CARE GROUP, LLC
Doing business as
Renal Care Group Prescott
Practice address
13175 E Highway 169
Dewey, AZ 86327-7372
Phone
(928) 713-5122
NPI assigned
Aug 31, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Fawcett
Title
Treasurer
Phone
(781) 402-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

13175 E Highway 169
Dewey, AZ 86327-7372

Mailing address

13175 E Highway 169
Dewey, AZ 86327-7372

Other names 1

  • RENAL CARE GROUP PRESCOTT Doing business as

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386756195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13175 E HIGHWAY 169",
            "city": "DEWEY",
            "state": "AZ",
            "postal_code": "863277372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13175 E HIGHWAY 169",
            "city": "DEWEY",
            "state": "AZ",
            "postal_code": "863277372",
            "telephone_number": "928-713-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT RENAL CARE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAWCETT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "781-402-9000"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RENAL CARE GROUP PRESCOTT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dewey, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.