MEDICARE: WISSOTA 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235646845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISSOTA DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L & C DEPARTMENT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4214
Fax Number	:	866-944-3352

Provider Business Practice Location Address
First Line	:	13912 US HIGHWAY 29
Second Line	:
City	:	CHATHAM
State	:	VA
Zip	:	24531-3669
Country	:	US
Telephone Number	:	434-432-1790
Fax Number	:	434-432-1785

Authorized Official
Title or Position	:	VP LICENSURE & CERTIFICATION
Name	:	SAMUEL WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	12/11/2023

Similar Medicare Providers

1518960673 — DR. MINESH SHAH M.D.
Practice Location Address:

13908 US HIGHWAY 29
CHATHAM, VA
24531-3669

Practice Phone: 434-432-0216
Practice Fax: 434-432-3425

1003925140 — JOSEPH R. SCEARCE
Practice Location Address:

13920 US HIGHWAY 29
CHATHAM, VA
24531-3669

Practice Phone: 434-432-1680
Practice Fax:

1225237456 — CHATHAM FAMILY MEDICAL CENTER, INC
Practice Location Address:

13908 US HIGHWAY 29
CHATHAM, VA
24531-3669

Practice Phone: 434-432-0216
Practice Fax: 434-432-3425

1568464709 — THOMPSON FAMILY MEDICAL CENTER, PC
Practice Location Address:

19144 US HIGHWAY 29
CHATHAM, VA
24531-5253

Practice Phone: 434-432-0216
Practice Fax:

1588647135 — COMMONWEALTH OF VA STATE BOARD OF HEALTH
Practice Location Address:

200 H G MC GHEE DR
CHATHAM, VA
24531

Practice Phone: 434-432-7232
Practice Fax: 434-432-7235

1912963539 — MS. DIANE G SCOTT FNP
Practice Location Address:

200 HG MCGLEE DRIVE
CHATHAM, VA
24531

Practice Phone: 434-432-7232
Practice Fax: 434-432-7235

Directions to “WISSOTA DIALYSIS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.