Organization
WYOTA DIALYSIS, LLC
Active
Other names
Livingston Village 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
11700 LIVINGSTON RD, FORT WASHINGTON, MD 20744-5150
(301) 292-1804
(301) 292-9828
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPARTMENT, 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
—
502430700
—
MD
Enumeration date
07/25/2018
Last updated
09/12/2024
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