NPIMap

Organization Active NPI

Renal Treatment Centers-Southeast, LP.

Doing business as Longview Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Longview, TX
National Provider Identifier
1316900137
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
006168 Issued in TX
Legal business name
RENAL TREATMENT CENTERS-SOUTHEAST, LP.
Doing business as
Longview Dialysis Center
Practice address
3110 H G Mosley Pkwy Ste 100
Longview, TX 75605-2941
Phone
(430) 240-8224
Fax
(903) 234-8521
NPI assigned
Apr 11, 2006
Last updated
Apr 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Authorized official

Name
Samuel T Wey
Title
VP Licensure&Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 006168 TX Primary

Addresses

Primary practice location

3110 H G Mosley Pkwy Ste 100
Longview, TX 75605-2941

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
139629305MedicaidTX

Other names 1

  • Longview Dialysis Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151221000921 TX Part A Provider - End-Stage Renal Disease Facility (ESRD) 1658555255 Practice locations: Longview, TX

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Longview Dialysis CenterCCN 452744
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Sep 18, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
36

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0915104Longview Dialysis Center3110 H G Mosley Parkway, Longview, TX 75605Certificate of waiverOct 8, 2026

National Provider Directory

National Provider Directory
Tax ID family
Bradley County Dialysis137 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Affiliated clinicians 7

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

NPI Registry JSON

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1316900137",
    "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": "3110 H G MOSLEY PKWY STE 100",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052941",
            "telephone_number": "430-240-8224",
            "fax_number": "903-234-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-SOUTHEAST, LP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "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": "TX",
            "license": "006168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139629305",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Longview Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Longview Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; 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.