Organization
NRA VARNVILLE SOUTH CAROLINA LLC
Active
Organization
NRA VARNVILLE SOUTH CAROLINA LLC
Active
Other names
Hampton Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON M. SUNDOCK (VICE PRESIDENT)
(615) 507-3307
Entity
Organization
Contact information
Practice address
593 W CAROLINA AVE, VARNVILLE, SC 29944-4735
(803) 943-4334
(803) 943-2092
Mailing address
1550 W. MCEWEN DRIVE, SUITE 500, FRANKLIN, TN 37067-1731
(615) 661-1100
(615) 507-3300
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ERD-125
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42D1005470
CLIA CERTIFICATE OF WAIVE
SC
05
—
ERD125
—
SC
Enumeration date
05/27/2006
Last updated
02/10/2011
Update your record
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