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General NPI Number Information
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NPI Number | 1497792337
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Entity Type | Organization
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Legal Business Name | NRA BAY CITY L.P.
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 1105 AVENUE H
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City | BAY CITY
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State | TX
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Zip | 77414-3538
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Country | US
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Telephone | 979-245-0099
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Fax | 979-245-6435
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Provider Business Mailing Address
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Address Line | 1105 AVENUE H
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City | BAY CITY
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State | TX
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Zip | 77414-3538
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Country | US
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Telephone | 979-245-0099
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Fax | 979-245-6435
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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 | 007998
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License Number State | TX
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