Provider Demographics
NPI:1497792337
Name:NRA BAY CITY L.P.
Entity Type:Organization
Organization Name:NRA BAY CITY L.P.
Other - Org Name:MATAGORDA RENAL DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:1105 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3538
Mailing Address - Country:US
Mailing Address - Phone:979-245-0099
Mailing Address - Fax:979-245-6435
Practice Address - Street 1:1105 AVENUE H
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3538
Practice Address - Country:US
Practice Address - Phone:979-245-0099
Practice Address - Fax:979-245-6435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007998261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1539445Medicaid
TX013425Medicaid
TX45D1016253OtherCLIA CERTIFICATE OF WAIVE
TX1539445Medicaid