Organization
BRACHE DIALYSIS LLC
Active
Other names
Kennedy Boulevard 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
2205 W KENNEDY BLVD, TAMPA, FL 33606-1536
(813) 254-3638
(813) 254-3809
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
—
017606800
—
FL
Enumeration date
05/13/2015
Last updated
08/21/2025
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