Organization
BLUEGRASS DIALYSIS LLC
Active
Other names
12th Street Covington 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
1500 JAMES SIMPSON JR WAY, STE 1100, COVINGTON, KY 41011-0802
(859) 261-4345
(859) 261-4378
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
300215
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100116930
—
KY
Enumeration date
05/18/2009
Last updated
06/18/2025
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