MEDICARE: CHWY PARTNERS, 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

General Provider Information

NPI Number	:	1902552789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHWY PARTNERS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 251549
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-1500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 PRAIRIE AVE STE 102
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-4833
Country	:	US
Telephone Number	:	307-213-7679
Fax Number	:	307-222-7888

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	THOMAS L WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/01/2022

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