MEDICARE: WILLISTON 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

Other Identifiers

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

General Provider Information

NPI Number	:	1831544972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLISTON DIALYSIS, LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L & C DEPARTMENT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4214
Fax Number	:	866-944-3352

Provider Business Practice Location Address
First Line	:	1375 OCEANA BLVD
Second Line	:	SUITE 114
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5579
Country	:	US
Telephone Number	:	757-961-6239
Fax Number	:	757-961-6665

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

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	03/18/2024

Similar Medicare Providers

1871691295 — DR. BRIDGET ANN SUNDELL MD
Practice Location Address:

602 N 6TH AVE W
VIRGINIA, MN
55792-5579

Practice Phone: 218-741-4111
Practice Fax: 218-741-8966

1225021017 — DR. ALEXANDER WONG O.D.
Practice Location Address:

555 E PACIFIC COAST HWY , STE 101
LONG BEACH, CA
90806-5579

Practice Phone: 562-494-9958
Practice Fax: 562-494-0950

1023278595 — DR. ADOLFO N TORRE PHARM. D.
Practice Location Address:

800 WEST AVE , #205
MIAMI BEACH, FL
33139-5579

Practice Phone: 954-000-0000
Practice Fax:

1427408509 — RUTH CROWELL
Practice Location Address:

6659 HARBOUR BLVD
PANAMA CITY BEACH, FL
32407-5579

Practice Phone: 850-819-2583
Practice Fax: 386-767-4319

1295237246 — AFFILIATED PARTNERS IPA
Practice Location Address:

555 E PACIFIC COAST HWY , STE 102
LONG BEACH, CA
90806-5579

Practice Phone: 562-287-8887
Practice Fax:

1144864992 — JONATHAN NGUYEN MEDICAL CLINIC INC
Practice Location Address:

555 E PACIFIC COAST HWY STE 102
LONG BEACH, CA
90806-5579

Practice Phone: 562-591-3222
Practice Fax:

Directions to “WILLISTON DIALYSIS, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.