Active NPI
Tyler Dialysis LLC
Doing business as Lourdes Innova Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Mount Laurel, NJ
National Provider Identifier
1215287941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- 24255
- Legal business name
- TYLER DIALYSIS LLC
- Doing business as
- Lourdes Innova Dialysis
- Practice address
- 3716 Church Rd
Mount Laurel, NJ 08054-1104 - Phone
- (856) 222-0386
- Fax
- (856) 235-0592
- NPI assigned
- Sep 10, 2012
- Last updated
- Mar 6, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Samuel Wey
- Title
- VP, Licensure & Certification
- Phone
- (615) 341-6641
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 24255 | NJ | Primary |
Addresses
Primary practice location
3716 Church Rd
Mount Laurel, NJ 08054-1104
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0318213 | Medicaid | NJ |
Other names 1
- Lourdes Innova Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120919000716 | NJ | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 4284882036 | Practice locations: Mount Laurel, NJ |
Other NPIs with the same Medicare PAC ID 4
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Brooklawn Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Brooklawn, NJ
- NPI 1154789659
4284882036
-
dba South Jersey Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Pennsauken, NJ
- NPI 1235807116
4284882036
-
dba Lourdes Mt Laurel Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Mount Laurel, NJ
- NPI 1760732408
4284882036
-
dba Lourdes Camden Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Camden, NJ
- NPI 1891044756
4284882036
National Provider Directory
National Provider Directory- Tax ID family
- Lourdes Camden Dialysis
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Mount Laurel, NJ
- NPI 1134373905
-
dba South Jersey Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Pennsauken, NJ
- NPI 1235807116
-
dba Lourdes Mt Laurel Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Mount Laurel, NJ
- NPI 1760732408
-
dba Lourdes Camden Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Camden, NJ
- NPI 1891044756
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba TRC Children's Dialysis Center
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Chicago, IL
- NPI 1396704508
Member Of
-
dba Barren County Dialysis
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Glasgow, KY
- NPI 1407496557
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347235200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1772755200000",
"number": "1215287941",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3716 CHURCH RD",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "080541104",
"telephone_number": "856-222-0386",
"fax_number": "856-235-0592"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TYLER DIALYSIS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2012-09-10",
"last_updated": "2026-03-06",
"certification_date": "2026-03-06",
"status": "A",
"authorized_official_last_name": "WEY",
"authorized_official_first_name": "SAMUEL",
"authorized_official_title_or_position": "VP, LICENSURE & CERTIFICATION",
"authorized_official_telephone_number": "615-341-6641"
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "NJ",
"license": "24255",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0318213",
"state": "NJ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Lourdes Innova Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Lourdes Innova Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mount Laurel, NJ
- Andre T Tucker
- Richard G Tucker, D.O.
- Jinky V Tugade, THERAPY DIR. I
- Turbo Health Associates (The Mindful Wellness Place)
- Twin Oaks Community Services, Inc
- Tyler Dialysis LLC (Lourdes Mt Laurel Dialysis)
- Morgan Tyson
- U.S. Healthworks Medical Group of New Jersey, PC
- Nneka Tionne Udoye, RBT
- Marco Canlas Udpaga, PT, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.