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
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