Basic Information
| Provider Information | |||||||||
| NPI: | 1740433648 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RENAL CARE CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 OSBORNE ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159054146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145390798 | ||||||||
| FaxNumber: | 8145364751 | ||||||||
| Practice Location | |||||||||
| Address1: | 88 OSBORNE ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159054146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145390798 | ||||||||
| FaxNumber: | 8145364751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2008 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | FREM | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8145390798 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA002696L | PA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207RN0300X | MD042825E | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.