Organization
KINGSTON DIALYSIS LLC
Active
Other names
Longmont Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1715 IRON HORSE DR STE 170, LONGMONT, CO 80501-9617
(303) 485-4084
(303) 485-4081
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
—
11485884
—
CO
01
—
1203KY
STATE LICENSE
CO
Enumeration date
08/28/2015
Last updated
02/04/2025
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