Organization
GREEN COUNTRY DIALYSIS LLC
Active
Other names
Green Country Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
5250 UTICA RIDGE RD, DAVENPORT, IA 52807-3872
(563) 355-7913
(563) 355-4007
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
—
1881975662
—
IA
Enumeration date
09/07/2011
Last updated
09/17/2025
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