Organization
NICONA DIALYSIS LLC
Active
Other names
Brodie Lane 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
9010 BRODIE LANE, BLDG A, AUSTIN, TX 78748-5184
(512) 280-6505
(512) 280-6866
Mailing address
5200 VIRGINIA WAY, 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
—
4087009-01
—
TX
Enumeration date
05/21/2019
Last updated
02/20/2025
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