Toltec Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

TOLTEC DIALYSIS LLC

Doing business as

College City Dialysis

Practice address

2630 Donaghey Ave
Conway, AR 72032-2308

Phone

(501) 504-2474

Fax

(501) 504-2611

NPI assigned

Apr 11, 2018

Last updated

Oct 9, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel T Wey

Title

Sr Director Licensure&Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• College City Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Listed as

DaVita College City DialysisCCN 042598

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Oct 12, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

20

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Dva Healthcare Renal Care Inc

  dba Amelia Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Amelia Court House, VA
  • NPI 1861456113

  Member Of

  NPD member
• Isd Renal, Inc.

  dba Navarre Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Navarre, OH
  • NPI 1134615651

  Member Of

  NPD member

Locations

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Mary J Shaver, M.D.

  • Nephrology Physician
  • Conway, AR
  • NPI 1497746341

  Dialysis facility

  Care Compare affiliation Name & address match
• Vikas Vujjini, M.D.

  • Nephrology Physician
  • Little Rock, AR
  • NPI 1275989907

  Dialysis facility

  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1073010518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L& C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4268",
            "fax_number": "877-238-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 DONAGHEY AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720322308",
            "telephone_number": "501-504-2474",
            "fax_number": "501-504-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOLTEC DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-11",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SR DIRECTOR LICENSURE&CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230940134",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "College City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "College City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Audrey Tobey, MD
• Solomon Tobi
• Charles L Todd, O.D.
• Mohamed Tolba, M.D.
• Odes Tolbert, RECOVERY ASSISTANT
• Tom Hudson LLC (Conway Dermatology Clinic)
• Detra Shondrealle Toney Clark, LCSW
• Katrina Toney, RECOVERY ASSISTANT
• Elizabeth Toone, OT
• Ruben Toth

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Conway, AR
• Providers in Conway, AR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.