Organization
ST LUKES DIALYSIS LLC
Active
Other names
Shaker Square Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
12800 SHAKER BLVD, STE 1, CLEVELAND, OH 44120-2000
(216) 491-4867
(216) 491-4925
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0294DC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2823207
—
OH
Enumeration date
01/11/2007
Last updated
07/11/2024
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