Organization
WOODFORD DIALYSIS, LLC
Active
Other names
North Brevard 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
250 HARRISON ST, STE 110, TITUSVILLE, FL 32780-5098
(321) 383-1345
(321) 268-4875
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
—
023008300
—
FL
Enumeration date
06/09/2016
Last updated
12/18/2024
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