Organization
NRA DICKSON TENNESSEE LLC
Active
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
Update your record
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