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NPI Code Detail

MEDICARE: SIMEON DIALYSIS LLC

MEDICARE: SIMEON 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/Center22344NJ

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 : 1205104841
Entity Type Code : Organization
Provider Name (Legal Business Name) : SIMEON 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 :
Fax Number :
Provider Business Practice Location Address
First Line : 57 WILLOWBROOK BLVD
Second Line : FL 2
City : WAYNE
State : NJ
Zip : 07470-7045
Country : US
Telephone Number : 973-890-2792
Fax Number : 973-890-2796
Authorized Official
Title or Position : VP LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 12/11/2011
Last Update Date : 03/04/2026

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Directions to “SIMEON DIALYSIS LLC ” Practice Location

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