Organization
WALLOWA DIALYSIS LLC
Active
Other names
Mid Ohio 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
2148 W 4TH ST, ONTARIO, OH 44906-1200
(419) 747-4039
(419) 747-4046
Mailing address
5200 VIRGINIA WAY, L & C DEPARTMENT, BRENTWOOD, TN 37027-7569
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
—
0100014
—
OH
Enumeration date
10/02/2012
Last updated
09/15/2025
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