Provider Demographics
NPI:1265489686
Name:NRA-CROSSVILLE, TENNESSEE, LLC
Entity Type:Organization
Organization Name:NRA-CROSSVILLE, TENNESSEE, LLC
Other - Org Name:CROSSVILLE DIALYSIS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:121 DOOLEY ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4075
Mailing Address - Country:US
Mailing Address - Phone:931-484-4500
Mailing Address - Fax:931-484-2130
Practice Address - Street 1:121 DOOLEY ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4075
Practice Address - Country:US
Practice Address - Phone:931-484-4500
Practice Address - Fax:931-484-2130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-30
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000148261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0442656Medicaid
TN44D1034070OtherCLIA CERTIFICATE OF WAIVE
TN442656Medicare Oscar/Certification