Healthcare Provider Details

I. General information

NPI: 1982641825
Provider Name (Legal Business Name): NRA-MCMINNVILLE, TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 SPARTA ST
MC MINNVILLE TN
37110-1317
US

IV. Provider business mailing address

PO BOX 251549
PLANO TX
75025-1500
US

V. Phone/Fax

Practice location:
  • Phone: 931-507-5700
  • Fax: 931-507-5704
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number0000000157
License Number StateTN

VIII. Authorized Official

Name: THOMAS L. WEINBERG
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 214-736-2700