Healthcare Provider Details

I. General information

NPI: 1518705524
Provider Name (Legal Business Name): LONECOVE DIALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 WELLS RD STE 105
ORANGE PARK FL
32073-6780
US

IV. Provider business mailing address

5200 VIRGINIA WAY
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 904-510-0778
  • Fax: 904-809-7750
Mailing address:
  • Phone:
  • 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: SAMUEL WEY
Title or Position: VP LICENSURE AND CERTIFICATION
Credential:
Phone: 615-341-6641