Organization
BULLOCK DIALYSIS LLC
Active
Parent organization
DAVITA INC
Other names
Queen City Dialysis
Organization subpart
Yes
Provider details
NPI number
Legal business name
DAVITA INC
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2290 FERGUSON RD, CINCINNATI, OH 45238
(513) 347-3626
(513) 347-2680
Mailing address
5200 VIRGINIA WAY, ATT: 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
Enumeration date
11/22/2019
Last updated
09/03/2025
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