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General NPI Number Information
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NPI Number | 1376522771
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Entity Type | Organization
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Legal Business Name | NRA LONDON KENTUCKY LLC
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 775 N LAUREL RD
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City | LONDON
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State | KY
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Zip | 40741-6025
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Country | US
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Telephone | 606-862-8888
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Fax | 606-862-8890
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Provider Business Mailing Address
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Address Line | 775 N LAUREL RD SUITE 500
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City | LONDON
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State | KY
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Zip | 40741-6025
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Country | US
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Telephone | 606-862-8888
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Fax | 606-862-8890
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Authorized Official
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Title or Position | TREASURER
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Name | MR. MARK R. FAWCETT
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Credential |
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Telephone | 781-699-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 330159
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License Number State | KY
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