Organization
SOUTHWEST KIDNEY DAVITA DIALYSIS PARTNERS LLC
Active
Other names
Wickenburg 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
811 N TEGNER ST, SUITES 101, 103, 105, 107, WICKENBURG, AZ 85390-5409
(928) 684-6898
(928) 684-6107
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
—
787101
—
AZ
Enumeration date
04/05/2012
Last updated
01/02/2025
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