MEDICARE: NRA MUNCIE INDIANA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15D1064293	OTHER	IN	CLIA CERT OF WAIVER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275693111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NRA MUNCIE INDIANA LLC

Provider Business Mailing Address
First Line	:	424 CHURCH ST
Second Line	:	SUITE 1900
City	:	NASHVILLE
State	:	TN
Zip	:	37219-2301
Country	:	US
Telephone Number	:	615-263-4518
Fax Number	:

Provider Business Practice Location Address
First Line	:	2705 W NORTH ST
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47303-3415
Country	:	US
Telephone Number	:	765-747-3020
Fax Number	:	317-741-1588

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	03/31/2016

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