MEDICARE: GARRETT 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	1118DC	OH

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	:	1407256092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARRETT DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	ATT: L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-238-3051
Fax Number	:	800-246-8346

Provider Business Practice Location Address
First Line	:	4805 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5145
Country	:	US
Telephone Number	:	216-398-6029
Fax Number	:	216-398-6053

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JOHN D WINSTEL
Credential	:
Telephone Number	:	253-733-4501

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	05/30/2023

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