Healthcare Provider Details

I. General information

NPI: 1497792337
Provider Name (Legal Business Name): NRA BAY CITY L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 AVENUE H
BAY CITY TX
77414-3538
US

IV. Provider business mailing address

1105 AVENUE H
BAY CITY TX
77414-3538
US

V. Phone/Fax

Practice location:
  • Phone: 979-245-0099
  • Fax: 979-245-6435
Mailing address:
  • Phone: 979-245-0099
  • Fax: 979-245-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number007998
License Number StateTX

VIII. Authorized Official

Name: MR. MARK R. FAWCETT
Title or Position: TREASURER
Credential:
Phone: 781-699-9000