Organization
LATROBE DIALYSIS LLC
Active
Other names
TN Smokie Mountain 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
2320 KNOB CREEK RD STE 408, JOHNSON CITY, TN 37604-2581
(423) 232-1969
(423) 232-0320
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4514
(866) 594-9961
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
158
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0442668
—
TN
Enumeration date
01/03/2012
Last updated
03/11/2024
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