Organization
ALAMOSA DIALYSIS LLC
Active
Other names
Port Lavaca Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1300 N VIRGINIA ST, STE 102, PORT LAVACA, TX 77979-2512
(361) 552-3800
(361) 552-8703
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
008733
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2025991-02
—
TX
Enumeration date
09/23/2008
Last updated
04/21/2025
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