Organization
ICELANDIC DIALYSIS LLC
Active
Other names
Medina Square 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
740 N COURT ST, MEDINA, OH 44256-1748
(330) 721-7824
(330) 721-9540
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
Enumeration date
09/13/2017
Last updated
08/21/2024
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