Organization
BEVERLY DIALYSIS LLC
Active
Other names
Mountaineer Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2958 ROBERT C BYRD DR, BECKLEY, WV 25801-4448
(304) 252-9183
(304) 252-9194
Mailing address
5200 VIRGINIA WAY, L & C DEPT, BRENTWOOD, TN 37027-7569
(615) 238-3051
(800) 246-8346
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
—
3910007007
—
WV
Enumeration date
01/30/2013
Last updated
02/02/2024
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