| Organization Name: | NRA BAMBERG SOUTH CAROLINA LLC |
| NPI Number: | 1073560645 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK R. FAWCETT (TREASURER) |
| Mailing Address: | 2046 Main Hwy Bamberg |
| State: | SC US |
| Postal Code: | 290031082 |
| Phone Number: | 8032451775 |
| Fax Number: | 8032459390 |
| NPI Enumeration Date: | 05/28/2006 |
| NPI Last Update Date: | 04/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | ERD-136 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |