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NPI Code Detail

MEDICARE: TYLER DIALYSIS LLC

MEDICARE: TYLER 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/Center24255NJ

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 : 1215287941
Entity Type Code : Organization
Provider Name (Legal Business Name) : TYLER 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 : 3716 CHURCH RD
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-1104
Country : US
Telephone Number : 856-222-0386
Fax Number : 856-235-0592
Authorized Official
Title or Position : VP, LICENSURE & CERTIFICATION
Name : SAMUEL WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 09/10/2012
Last Update Date : 03/06/2026

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