Healthcare Provider Details

I. General information

NPI: 1336054832
Provider Name (Legal Business Name): SOUTHWEST KIDNEY DAVITA DIALYSIS PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 EAST MONUMENT PLAZA CIRCLE SUITE 102
CASA GRANDE AZ
85122-0056
US

IV. Provider business mailing address

5200 VIRGINIA WAY
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 520-494-3090
  • Fax: 520-494-3044
Mailing address:
  • Phone: 615-554-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAM T WEY
Title or Position: VP LICENSURE & CERTIFICATION
Credential:
Phone: 615-341-6691