Organization
PETRA DIALYSIS LLC
Active
Other names
Indio 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
82900 AVENUE 42, STE E, INDIO, CA 92203-9658
(760) 342-6842
(760) 342-6807
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 238-3085
(800) 268-9682
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
—
1710439187
—
CA
Enumeration date
11/01/2016
Last updated
05/10/2024
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