Fredericktown Dialysis Clinic

LBN: Nra Fredericktown Missouri Llc
Fredericktown Dialysis Clinic is an health care organization with primary practice located at 105 Armory Street , Fredericktown MO 63645-1340. The organization recently has only one registered license in Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment, which is considered as the primary health care specialty. Nra Fredericktown Missouri Llc can be contacted via phone (573) 783-2089, or through Fawcett, Mark R. via phone (781) 699-9000.

Contact Information

Primary practice address
105 Armory Street Fredericktown MO 63645-1340
Phone: (573) 783-2089
Fax: (573) 783-7206
Website:
Map and Directions
Authorized official contact:
Name: Fawcett, Mark R.
Phone: (781) 699-9000

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment 261QE0700X NOT APPLICABLE Missouri

Profile Details

NPI number 1639378474
LBN Legal business name Nra Fredericktown Missouri Llc
DBA Doing business as Fredericktown Dialysis Clinic
Authorized official Fawcett, Mark R.
Entity Organization
Organization subpart 1 Yes
Enumeration date Jul 12th, 2007
Last updated Aug 15th, 2012 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639378474 NPPES
Missouri Other 26D1071779 CLIA CERT. OF WAIVER
Missouri MEDICAID 504928904 CLIA CERT. OF WAIVER

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