Organization
PATTISON DIALYSIS LLC
Active
Other names
Grant Line 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
2955 N CORRAL HOLLOW RD, STE 101, TRACY, CA 95376-8800
(209) 839-8302
(209) 839-8297
Mailing address
5200 VIRGINIA WAY, ATT: 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
—
1093211609
—
CA
Enumeration date
04/03/2018
Last updated
08/04/2025
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