Organization
ROSS CLARK CIRCLE DIALYSIS LLC
Active
Other names
Wiregrass Kidney Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1450 ROSS CLARK CIR, STE 200, DOTHAN, AL 36301-4770
(334) 792-8907
(334) 792-8912
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
S3503
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008910100
—
FL
05
—
067833571A
—
GA
05
—
1003070285
—
AL
Enumeration date
07/16/2008
Last updated
07/18/2025
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