MEDICARE: PARKSIDE 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	E2636	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E2636	OTHER	MD	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588088694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSIDE 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	:	6609 REISTERSTOWN RD
Second Line	:	STE 100
City	:	BALTIMORE
State	:	MD
Zip	:	21215-2662
Country	:	US
Telephone Number	:	410-358-1745
Fax Number	:	410-358-1526

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

Provider Enumeration Date	:	02/10/2014
Last Update Date	:	12/23/2025

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Directions to “PARKSIDE DIALYSIS LLC ” Practice Location

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