Provider Demographics
NPI:1578746277
Name:SOUTHWEST KIDNEY DAVITA DIALYSIS PARTNERS LLC
Entity Type:Organization
Organization Name:SOUTHWEST KIDNEY DAVITA DIALYSIS PARTNERS LLC
Other - Org Name:TEMPE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, LICENSURE & CERTIFICATION
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-341-6641
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:L&C DEPT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2149 E WARNER RD
Practice Address - Street 2:STE 110
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3496
Practice Address - Country:US
Practice Address - Phone:480-730-3531
Practice Address - Fax:480-491-5964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ361398Medicaid
AZ032609Medicare Oscar/Certification