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General NPI Number Information
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NPI Number | 1144742941
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Entity Type | Organization
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Legal Business Name | MISSION MEDICAL LLC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 206B COOL SPRINGS BLVD STE 202
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City | FRANKLIN
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State | TN
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Zip | 37067-7292
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Country | US
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Telephone | 615-465-6642
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Fax | 615-224-3593
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Provider Business Mailing Address
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Address Line | 206B COOL SPRINGS BLVD STE 202
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City | FRANKLIN
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State | TN
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Zip | 37067-7292
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Country | US
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Telephone | 615-465-6642
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Fax | 615-224-3593
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Authorized Official
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Title or Position | OWNER
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Name | RONSON DYKSTRA
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Credential | DC
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Telephone | 615-465-6642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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