Provider Demographics
NPI:1477500890
Name:NRA-NORTH AUGUSTA, SOUTH CAROLINA, LLC
Entity Type:Organization
Organization Name:NRA-NORTH AUGUSTA, SOUTH CAROLINA, LLC
Other - Org Name:FRESENIUS MEDICAL CARE ATOMIC ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:10263 ATOMIC RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-4484
Mailing Address - Country:US
Mailing Address - Phone:803-279-3722
Mailing Address - Fax:803-279-3461
Practice Address - Street 1:10263 ATOMIC RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-4484
Practice Address - Country:US
Practice Address - Phone:803-279-3722
Practice Address - Fax:803-279-3461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-30
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCERD-173261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42D1057702OtherCLIA CERTIFICATE OF WAIVE
SCERD173Medicaid
SC422607Medicare Oscar/Certification