Organization
CLEBURNE DIALYSIS LLC
Active
Other names
Coral Hills 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
4797 MARLBORO PIKE, CAPITOL HEIGHTS, MD 20743-5213
(301) 420-1513
(301) 420-3912
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
(615) 320-4214
(866) 944-3352
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2683
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
422880400
—
MD
Enumeration date
11/06/2012
Last updated
10/31/2023
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