Provider Demographics
NPI:1285677963
Name:NRA-MT. PLEASANT, SOUTH CAROLINA, LLC
Entity Type:Organization
Organization Name:NRA-MT. PLEASANT, SOUTH CAROLINA, LLC
Other - Org Name:FRESENIUS MEDICAL CARE MOUNT PLEASANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:1028 EWALL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3046
Mailing Address - Country:US
Mailing Address - Phone:843-884-3115
Mailing Address - Fax:843-884-3190
Practice Address - Street 1:1028 EWALL ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3046
Practice Address - Country:US
Practice Address - Phone:843-884-3115
Practice Address - Fax:843-884-3190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCERD-148261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCERD-148Medicaid
SC42D1044300OtherCLIA CERTIFICATE OF WAIVE
SC42-2601Medicare Oscar/Certification