MEDICARE: NORTH MAIN KIDNEY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104143460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH MAIN KIDNEY CENTER LLC

Provider Business Mailing Address
First Line	:	3900 NORTH MAIN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6445
Country	:	US
Telephone Number	:	803-779-1201
Fax Number	:	803-779-1202

Provider Business Practice Location Address
First Line	:	3900 NORTH MAIN ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6445
Country	:	US
Telephone Number	:	803-779-1201
Fax Number	:	803-779-1202

Authorized Official
Title or Position	:	CHIEF NURSING OFFICER
Name	:	SARA ANNE BRADY
Credential	:
Telephone Number	:	208-371-7878

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	01/10/2023

Similar Medicare Providers

1912229865 — MONA DEVEN SHROFF O.D.
Practice Location Address:

6445 SWIMMER ROW WAY
COLUMBIA, MD
21044-4962

Practice Phone: 443-983-2020
Practice Fax:

1841758034 — JULIA KIM RING
Practice Location Address:

2700 GREEN VALLEY DR APT 107
COLUMBIA, MO
65201-6445

Practice Phone: 573-823-5621
Practice Fax:

1821696949 — LEXINGTON HEALTH INC
Practice Location Address:

21 GATEWAY CORNERS PARK STE 101
COLUMBIA, SC
29203-8906

Practice Phone: 803-419-4949
Practice Fax: 803-419-6445

1316562838 — TREVOR LLOYD MORRIS MD
Practice Location Address:

229 LONGTOWN RD
COLUMBIA, SC
29229-8550

Practice Phone: 803-419-4949
Practice Fax: 803-419-6445

1063143519 — MARISSA LYNN GENTLE DMD
Practice Location Address:

10 RICHLAND MEDICAL PARK DR STE A
COLUMBIA, SC
29203-6892

Practice Phone: 803-434-6567
Practice Fax: 803-434-6299

1407484041 — VISTINA METTS JOHNSON
Practice Location Address:

3 RICHLAND MEDICAL PARK DR STE 510
COLUMBIA, SC
29203-6854

Practice Phone: 803-296-2726
Practice Fax: 803-296-3319

Directions to “NORTH MAIN KIDNEY CENTER LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.