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NPI Code Detail

MEDICARE: BAINBRIDGE DIALYSIS LLC

MEDICARE: BAINBRIDGE 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 : 1699041152
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAINBRIDGE 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 : 1000 SAINT LOUIS AVE STE 101
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3377
Country : US
Telephone Number : 817-810-0379
Fax Number : 817-870-9767
Authorized Official
Title or Position : VP LICENSURE&CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 03/29/2012
Last Update Date : 02/20/2026

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Directions to “BAINBRIDGE DIALYSIS LLC ” Practice Location

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