1033148861 NPI number — NRA-COSHOCTON, OHIO, LLC

Table of content: (NPI 1033148861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033148861 NPI number — NRA-COSHOCTON, OHIO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NRA-COSHOCTON, OHIO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIALYSIS SERVICES OF COSHOCTON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033148861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 COOL SPRINGS BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-7289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-771-4400
Provider Business Mailing Address Fax Number:
615-771-4401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 KENWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COSHOCTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43812-1997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-622-6474
Provider Business Practice Location Address Fax Number:
740-622-6476
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASHIA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CHIEF MANAGER
Authorized Official Telephone Number:
615-771-4400

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  PENDING , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING . This is a "CLIA CERTIFICATE OF WAIVE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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