Provider Demographics
NPI:1548227390
Name:NRA-WASHINGTON COUNTY, MISSOURI, LLC
Entity Type:Organization
Organization Name:NRA-WASHINGTON COUNTY, MISSOURI, LLC
Other - Org Name:FRESENIUS KIDNEY CARE POTOSI
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 1:600 PURCELL RD
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1455
Mailing Address - Country:US
Mailing Address - Phone:573-436-0723
Mailing Address - Fax:573-438-1001
Practice Address - Street 1:600 PURCELL RD
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1455
Practice Address - Country:US
Practice Address - Phone:573-436-0723
Practice Address - Fax:573-438-1001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MON/A261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506908607Medicaid
MO26D1053681OtherCLIA CERT OF WAIVER
MO506908607Medicaid