Organization
LEASBURG DIALYSIS LLC
Active
Other names
Town and Country West Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
12855 N 40 DR, SUITE LL4, SAINT LOUIS, MO 63141-8657
(314) 542-0049
(314) 542-0057
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
—
1508159666
—
MO
Enumeration date
05/24/2011
Last updated
03/20/2025
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