Organization
TUMALO DIALYSIS LLC
Active
Other names
San Angelo 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
3518 KNICKERBOCKER RD, SAN ANGELO, TX 76904-7611
(325) 949-6035
(325) 949-6791
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
—
3347403-02
—
TX
Enumeration date
01/20/2012
Last updated
04/17/2024
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