Organization
CLINTON TOWNSHIP DIALYSIS LLC
Active
Other names
Clinton Township Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
15918 19 MILE RD, STE 110, CLINTON TOWNSHIP, MI 48038-1101
(586) 412-9195
(586) 412-9196
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4514
(866) 594-9961
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013101310
—
MI
Enumeration date
08/29/2007
Last updated
02/16/2024
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