MEDICARE: ATHIO 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	:	1396136222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHIO 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 WINDHAVEN PKWY
Second Line	:	STE 165
City	:	PLANO
State	:	TX
Zip	:	75093-8197
Country	:	US
Telephone Number	:	972-473-7891
Fax Number	:	972-473-0150

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

Provider Enumeration Date	:	02/13/2015
Last Update Date	:	06/02/2026

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Directions to “ATHIO DIALYSIS, LLC ” Practice Location

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