Healthcare Provider Details

I. General information

NPI: 1306129895
Provider Name (Legal Business Name): DIALYSIS NEWCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WHITMIRE RD
EASLEY SC
29640-1426
US

IV. Provider business mailing address

PO BOX 251549
PLANO TX
75025-1500
US

V. Phone/Fax

Practice location:
  • Phone: 864-855-6206
  • Fax: 864-855-6207
Mailing address:
  • Phone: 615-234-1188
  • Fax: 615-234-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberERD0170
License Number StateSC

VIII. Authorized Official

Name: THOMAS L. WEINBERG
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 214-736-2700