Organization
GLOSSER DIALYSIS LLC
Active
Other names
BROADWAY 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
2624 STOCKTON BLVD, SACRAMENTO, CA 95817-2210
(916) 457-0113
(916) 457-0116
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
550003576
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568847929
—
CA
Enumeration date
07/28/2015
Last updated
07/08/2025
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