Organization
KINGSTON DIALYSIS LLC
Active
Other names
Boulder Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2880 FOLSOM ST STE 110, BOULDER, CO 80304
(303) 440-5600
(303) 440-4165
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
120301
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891162301
—
CO
Enumeration date
09/01/2015
Last updated
11/27/2024
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