Organization Name: | NRA WASHINGTON COUNTY MISSOURI LLC |
NPI Number: | 1548227390 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK R. FAWCETT (TREASURER) |
Mailing Address: | 828 E High St Suite 2 Potosi |
State: | MO US |
Postal Code: | 636641410 |
Phone Number: | 5734368085 |
Fax Number: | 5734368092 |
NPI Enumeration Date: | 04/26/2006 |
NPI Last Update Date: | 08/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | N/A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |