Organization
NRA NICHOLASVILLE KENTUCKY LLC
Active
Other names
Nicholasville Dialysis Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON M. SUNDOCK (VICE PRESIDENT)
(615) 507-3307
Entity
Organization
Contact information
Practice address
220 BELLAIRE DRIVE, NICHOLASVILLE, KY 40356
(859) 881-8118
(859) 881-8212
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
300190
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18D1071037
CLIA
KY
05
—
PENDING
—
KY
Enumeration date
05/09/2007
Last updated
02/10/2011
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