Organization
KIMBALL DIALYSIS LLC
Active
Other names
Commonwealth Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (SR DIR LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
920 S WASHINGTON AVE, SCRANTON, PA 18505-3810
(570) 344-5267
(570) 963-2125
Mailing address
5200 VIRGINIA WAY, L & C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6410
(888) 662-8259
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
—
1027729300001
—
PA
Enumeration date
03/24/2012
Last updated
09/19/2023
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