Provider Demographics
NPI:1912156894
Name:NRA-UNION SPRINGS, ALABAMA, LLC
Entity type:Organization
Organization Name:NRA-UNION SPRINGS, ALABAMA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUNDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-507-3307
Mailing Address - Street 1:115 EAST PARK DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2311
Mailing Address - Country:US
Mailing Address - Phone:615-661-1100
Mailing Address - Fax:615-507-3300
Practice Address - Street 1:109 CONECUH AVE W
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-1317
Practice Address - Country:US
Practice Address - Phone:334-738-5715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment