Nra Varnville South Carolina LLC

Primary specialty

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

License

ERD-125 Issued in SC

Legal business name

NRA VARNVILLE SOUTH CAROLINA LLC

Doing business as

Hampton Dialysis Center

Practice address

593 W Carolina Ave
Varnville, SC 29944-4735

Phone

(803) 943-4334

Fax

(803) 943-2092

NPI assigned

May 27, 2006

Last updated

Feb 10, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jon M. Sundock

Title

Vice President

Phone

(615) 507-3307

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Hampton Dialysis Center Doing business as

Locations

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297296000000",
    "number": "1831146687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 W. MCEWEN DRIVE",
            "address_2": "SUITE 500",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370671731",
            "telephone_number": "615-661-1100",
            "fax_number": "615-507-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 W CAROLINA AVE",
            "city": "VARNVILLE",
            "state": "SC",
            "postal_code": "299444735",
            "telephone_number": "803-943-4334",
            "fax_number": "803-943-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NRA VARNVILLE SOUTH CAROLINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2011-02-10",
        "status": "A",
        "authorized_official_last_name": "SUNDOCK",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-507-3307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "SC",
            "license": "ERD-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATE OF WAIVE",
            "identifier": "42D1005470",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ERD125",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hampton Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa Metzger, RPH
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• Rocio Alexsandra Mundo, RN
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• Heather Troutman Owens, FNP-C
• Brenda L Poalillo, APRN
• Catherine Renee Pritchard, NP
• Antony M Rea, DC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Varnville, SC
• Providers in Varnville, SC by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2011; 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.