Organization
NRA DICKSON TENNESSEE LLC
Active
Other names
Dickson 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
254 BEASLEY DR., DICKSON, TN 37055
(615) 771-4400
(615) 771-4401
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
0000000162
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44D1060788
CLIA CERT OF WAIVER
TN
Enumeration date
10/16/2006
Last updated
02/15/2011
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