Provider Demographics
NPI:1144742941
Name:MISSION MEDICAL LLC
Entity Type:Organization
Organization Name:MISSION MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-465-6642
Mailing Address - Street 1:206B COOL SPRINGS BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7292
Mailing Address - Country:US
Mailing Address - Phone:615-465-6642
Mailing Address - Fax:615-224-3593
Practice Address - Street 1:206B COOL SPRINGS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7292
Practice Address - Country:US
Practice Address - Phone:615-465-6642
Practice Address - Fax:615-224-3593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty