Organization
MACHESNEY BAY DIALYSIS LLC
Active
Other names
Machesney Park 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
7170 N PERRYVILLE RD, MACHESNEY PARK, IL 61115-7700
(815) 885-8132
(815) 885-8178
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
—
=========
—
IL
Enumeration date
11/17/2015
Last updated
06/05/2025
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