MEDICARE: LEOTI DIALYSIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1114610318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEOTI DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	ATT: L&C SPECIALIST
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 MONTGOMERY HWY STE 109
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-2508
Country	:	US
Telephone Number	:	659-272-0001
Fax Number	:	659-272-0019

Authorized Official
Title or Position	:	VP, LICENSURE & CERTIFICATION
Name	:	SAMUEL T WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	10/30/2025

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