MEDICARE: SOUTHWEST KIDNEY DAVITA DIALYSIS 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	:	1932688256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST KIDNEY DAVITA DIALYSIS PARTNERS 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	:	926 E MCDOWELL RD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2503
Country	:	US
Telephone Number	:	602-252-1418
Fax Number	:	602-252-1928

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

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	03/19/2026

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