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NPI Code Detail

MEDICARE: STEVENSON DIALYSIS, LLC

MEDICARE: STEVENSON 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 : 1215343215
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEVENSON 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 : 1310 MURCHISON DR
Second Line : STE C
City : EL PASO
State : TX
Zip : 79902-4821
Country : US
Telephone Number : 915-351-0893
Fax Number : 915-533-8516
Authorized Official
Title or Position : VP LICENSURE&CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 07/10/2014
Last Update Date : 03/12/2025

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Directions to “STEVENSON DIALYSIS, LLC ” Practice Location

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