MEDICARE: NRA-PORT LAVACA, TEXAS, 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	PENDING	TX

General Provider Information

NPI Number	:	1780743906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NRA-PORT LAVACA, TEXAS, LLC

Provider Business Mailing Address
First Line	:	730 COOL SPRINGS BLVD
Second Line	:	SUITE 100
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7289
Country	:	US
Telephone Number	:	615-771-4400
Fax Number	:	615-771-4401

Provider Business Practice Location Address
First Line	:	1300 N VIRGINIA ST
Second Line	:	SUITE 102
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2509
Country	:	US
Telephone Number	:	361-551-2566
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MANAGER
Name	:	MR. JOSEPH A CASHIA
Credential	:
Telephone Number	:	615-771-4400

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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