Basic Information
| Provider Information | |||||||||
| NPI: | 1144504705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIALYSIS NEWCO LLC | ||||||||
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| OtherOrganizationName: | DSI MEMPHIS SOUTH DIALYSIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 424 CHURCH STREET | ||||||||
| Address2: | SUITE 1900 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372192387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154670131 | ||||||||
| FaxNumber: | 6152342422 | ||||||||
| Practice Location | |||||||||
| Address1: | 3960 KNIGHT ARNOLD RD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381183001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013656709 | ||||||||
| FaxNumber: | 9013698129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2011 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | WEINBERG | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 2147362700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | U.S. RENAL CARE, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 0000000081 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.