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NPI Code Detail

MEDICARE: ST LUKES DIALYSIS LLC

MEDICARE: ST LUKES 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/Center0294DCOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780734012
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST LUKES DIALYSIS LLC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : ATT: L&C DEPT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12800 SHAKER BLVD
Second Line : STE 1
City : CLEVELAND
State : OH
Zip : 44120-2000
Country : US
Telephone Number : 216-491-4867
Fax Number : 216-491-4925
Authorized Official
Title or Position : VP LICENSURE & CERTIFICATION
Name : SAMUEL WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 01/11/2007
Last Update Date : 07/11/2024

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Directions to “ST LUKES DIALYSIS LLC ” Practice Location

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