Organization
ETOWAH DIALYSIS LLC
Active
Other names
St Luke's Tamaqua Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1215 E BROAD ST, STE 20, TAMAQUA, PA 18252-2229
(570) 668-3480
(570) 668-3483
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102924317
—
PA
Enumeration date
11/05/2018
Last updated
04/10/2026
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