Organization
MANZANO DIALYSIS LLC
Active
Other names
Midwest Fairborn 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
1266 N BROAD ST, FAIRBORN, OH 45324-5549
(937) 879-0433
(937) 879-0589
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
—
3071027
—
OH
Enumeration date
04/14/2010
Last updated
10/01/2025
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