Organization
CSRA RENAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS A STAHURA D.O. (PRESIDENT)
(803) 648-0718
Entity
Organization
Contact information
Practice address
755 MEDICAL PARK DR, AIKEN, SC 29801-6306
(803) 648-0718
(803) 641-9143
Mailing address
755 MEDICAL PARK DR, AIKEN, SC 29801-6306
(803) 648-0718
(803) 641-9143
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7953457
AETNA GROUP NUMBER
SC
05
—
GP3601
—
SC
05
—
GP4396
—
SC
Enumeration date
04/13/2006
Last updated
11/16/2016
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