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General NPI Number Information
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NPI Number | 1295799641
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Entity Type | Organization
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Legal Business Name | CSRA RENAL SERVICES, LLC
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 755 MEDICAL PARK DR
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City | AIKEN
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State | SC
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Zip | 29801-6306
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Country | US
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Telephone | 803-648-0718
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Fax | 803-641-9143
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Provider Business Mailing Address
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Address Line | 755 MEDICAL PARK DR
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City | AIKEN
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State | SC
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Zip | 29801-6306
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Country | US
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Telephone | 803-648-0718
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Fax | 803-641-9143
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS A STAHURA
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Credential | D.O.
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Telephone | 803-648-0718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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