Organization
SOMERVILLE DIALYSIS CENTER LLC
Active
Organization
SOMERVILLE DIALYSIS CENTER LLC
Active
Other names
Somerville Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
12475 US HIGHWAY 64, SOMERVILLE, TN 38068-6029
(901) 466-1919
(901) 466-1930
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4514
(866) 594-9961
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
—
0442683
—
TN
05
—
05677019
—
MS
05
—
176950134
—
AR
Enumeration date
05/16/2008
Last updated
05/16/2020
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