Organization
RENAL CENTER OF MOUNTAIN HOME LLC
Active
Other names
Renal Center of Mountain Home
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
200 E 8TH ST STE 101, MOUNTAIN HOME, AR 72653-4402
(870) 508-6500
(870) 508-6550
Mailing address
5200 VIRGINIA WAY, ATT: 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
—
146280734
—
AR
Enumeration date
06/02/2006
Last updated
03/30/2026
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