Healthcare Provider Details

I. General information

NPI: 1831146687
Provider Name (Legal Business Name): NRA VARNVILLE SOUTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 W CAROLINA AVE
VARNVILLE SC
29944-4735
US

IV. Provider business mailing address

1550 W. MCEWEN DRIVE SUITE 500
FRANKLIN TN
37067-1731
US

V. Phone/Fax

Practice location:
  • Phone: 803-943-4334
  • Fax: 803-943-2092
Mailing address:
  • Phone: 615-661-1100
  • Fax: 615-507-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberERD-125
License Number StateSC

VIII. Authorized Official

Name: MR. JON M. SUNDOCK
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-507-3307