Organization
BASTROP DIALYSIS LLC
Active
Other names
Dayton North 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
455 TURNER RD, STE A, DAYTON, OH 45415-3630
(937) 278-7861
(937) 278-8336
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
—
0088772
—
OH
Enumeration date
11/12/2012
Last updated
08/15/2024
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