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NPI Code Detail

MEDICARE: LLANO DIALYSIS LLC

MEDICARE: LLANO 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/Center

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 : 1063649242
Entity Type Code : Organization
Provider Name (Legal Business Name) : LLANO DIALYSIS LLC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : L&C DEPT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number : 615-238-3085
Fax Number : 800-268-9682
Provider Business Practice Location Address
First Line : 10690 SAN PABLO AVE
Second Line :
City : EL CERRITO
State : CA
Zip : 94530-2620
Country : US
Telephone Number : 510-528-9590
Fax Number : 510-528-9803
Authorized Official
Title or Position : SR DIR LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 06/16/2009
Last Update Date : 08/16/2023

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Directions to “LLANO DIALYSIS LLC ” Practice Location

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