Organization
RUSSELL DIALYSIS LLC
Active
Other names
Wylie 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
941 S WESTGATE WAY, WYLIE, TX 75098-4947
(972) 429-4315
(972) 429-8954
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6398
(866) 586-4152
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
—
319844201
—
TX
Enumeration date
11/07/2011
Last updated
03/20/2024
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