Organization
MASHERO DIALYSIS LLC
Active
Other names
Montana Vista 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
2204 JOE BATTLE BLVD STE A, EL PASO, TX 79938-4660
(915) 849-8374
(915) 849-8301
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
01
—
110347
STATE LICENSE
TX
05
—
3844276-01
—
TX
Enumeration date
02/17/2015
Last updated
08/15/2024
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