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NPI Code Detail

MEDICARE: BASTROP DIALYSIS LLC

MEDICARE: BASTROP 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 : 1114261393
Entity Type Code : Organization
Provider Name (Legal Business Name) : BASTROP DIALYSIS LLC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : ATT: L&C DEPT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 455 TURNER RD
Second Line : STE A
City : DAYTON
State : OH
Zip : 45415-3630
Country : US
Telephone Number : 937-278-7861
Fax Number : 937-278-8336
Authorized Official
Title or Position : VP, LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 11/12/2012
Last Update Date : 08/15/2024

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Directions to “BASTROP DIALYSIS LLC ” Practice Location

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