Nra Macon Georgia LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

ESRD001230 Issued in GA

Legal business name

NRA MACON GEORGIA LLC

Doing business as

Eisenhower Parkway Dialysis Center

Practice address

2525 2ND St
Macon, GA 31206-2223

Phone

(478) 738-0420

Fax

(478) 745-0460

NPI assigned

May 26, 2006

Organization subpart

Yes

Parent organization

RAI II, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jon M. Sundock

Title

Vice President

Phone

(615) 507-3307

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Eisenhower Parkway Dialysis Center Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• National Medical Care, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bristol, TN
  • NPI 1477570117

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437523200000",
    "number": "1033165154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 W. MCEWEN DRIVE",
            "address_2": "SUITE 500",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370671731",
            "telephone_number": "615-661-1100",
            "fax_number": "615-507-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 2ND ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312062223",
            "telephone_number": "478-738-0420",
            "fax_number": "478-745-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NRA MACON GEORGIA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RAI II, LLC",
        "enumeration_date": "2006-05-26",
        "last_updated": "2015-07-22",
        "status": "A",
        "authorized_official_last_name": "SUNDOCK",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-507-3307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD001230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "813786518A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATE OF WAIVE",
            "identifier": "11D1049748",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eisenhower Parkway Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Macon, GA
• Providers in Macon, GA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.