Organization
RENAL CENTER OF WATERTON, LLLP
Active
Other names
Renal Center of Waterton
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2895 SHILOH RD, TYLER, TX 75703-2936
(903) 561-0292
(903) 561-1896
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
—
280420501
—
TX
Enumeration date
09/18/2008
Last updated
06/17/2025
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