Organization
UKIAH DIALYSIS LLC
Active
Other names
College Park 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
17191 ST LUKES WAY STE 100, THE WOODLANDS, TX 77384-8043
(936) 273-3350
(936) 273-4539
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
—
3432759-01
—
TX
Enumeration date
07/01/2013
Last updated
07/17/2024
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