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NPI Code Detail

MEDICARE: MATHER DIALYSIS LLC

MEDICARE: MATHER 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1205399854
Entity Type Code : Organization
Provider Name (Legal Business Name) : MATHER DIALYSIS LLC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : ATT: L&C DEPARTMENT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1840 YORK RD STE A
Second Line :
City : LUTHERVILLE TIMONIUM
State : MD
Zip : 21093-5121
Country : US
Telephone Number : 410-252-8313
Fax Number : 410-252-8239
Authorized Official
Title or Position : VP LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 04/10/2019
Last Update Date : 03/06/2025

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