Organization
KOBUK DIALYSIS LLC
Active
Other names
Ottumwa Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1005 PENNSYLVANIA AVE STE 101, OTTUMWA, IA 52501-6408
(641) 682-1531
(641) 682-0794
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
—
1649517673
—
IA
Enumeration date
01/10/2013
Last updated
05/09/2025
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