Organization
KINGSTON DIALYSIS LLC
Active
Other names
Lakewood Crossing 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
1057 S WADSWORTH BLVD STE 100, LAKEWOOD, CO 80226
(720) 962-6199
(720) 962-6196
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
12044X
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922475672
—
CO
Enumeration date
08/28/2015
Last updated
10/15/2024
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