Nra Fredericktown Missouri LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

NOT APPLICABLE Issued in MO

Legal business name

NRA FREDERICKTOWN MISSOURI LLC

Practice address

105 Armory Street
Fredericktown, MO 63645-1340

Phone

(573) 783-2089

Fax

(573) 783-7206

NPI assigned

Jul 12, 2007

Organization subpart

Yes

Parent organization

FRESENIUS MEDICAL CARE HOLDINGS, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark R. Fawcett

Title

Treasurer

Phone

(781) 699-9000

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Fredericktown Dialysis Clinic Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• National Medical Care, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bristol, TN
  • NPI 1477570117

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344988800000",
    "number": "1639378474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 ARMORY STREET",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451340",
            "telephone_number": "573-783-2089",
            "fax_number": "573-783-7206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 ARMORY STREET",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451340",
            "telephone_number": "573-783-2089",
            "fax_number": "573-783-7206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NRA FREDERICKTOWN MISSOURI LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
        "enumeration_date": "2007-07-12",
        "last_updated": "2012-08-15",
        "status": "A",
        "authorized_official_last_name": "FAWCETT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "781-699-9000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MO",
            "license": "NOT APPLICABLE",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERT. OF WAIVER",
            "identifier": "26D1071779",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504928904",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fredericktown Dialysis Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Craig J. Millham, P.T.
• Modern Mental Health
• Sarah Pauline Mueller, PMHNP-BC
• Samantha Lee Musket, RMA
• N & R of Fredericktown, Inc.
• Patrick O'Hara
• Humberto Jose Olivero Lara, MD, MSPH
• Ozark Manor Inc
• Rhonda Ellen Palmer, MSW,LCSW
• Parkland Pharmacy Development LLC

• All providers in Fredericktown, MO
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.