Organization
MENA DIALYSIS CENTER LLC
Active
Other names
Mena Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1200 CRESTWOOD CIR, MENA, AR 71953-5516
(479) 394-8085
(479) 394-2164
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167685134
—
AR
05
—
200250880A
—
OK
Enumeration date
08/05/2007
Last updated
09/18/2024
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