Saddleback Dialysis LLC

Primary specialty

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

License

ESRD000739 Issued in GA

Legal business name

SADDLEBACK DIALYSIS LLC

Doing business as

Magnolia Oaks Dialysis

Practice address

2377 Hwy 196 W
Hinesville, GA 31313-8036

Phone

(912) 368-2710

Fax

(912) 368-2714

NPI assigned

Sep 27, 2010

Last updated

Sep 6, 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 Wey

Title

Sr Director Licensure&Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Magnolia Oaks Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Member of 2

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

• Total Renal Care Inc

  dba Cerritos Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cerritos, CA
  • NPI 1255681011

  Member Of

  NPD member
• Total Renal Care Inc

  dba Kenwood Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Chicago, IL
  • NPI 1831896364

  Member Of

  NPD member

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

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1508175464",
    "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": "2377 HWY 196 W",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313138036",
            "telephone_number": "912-368-2710",
            "fax_number": "912-368-2714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SADDLEBACK DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-27",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": "GA",
            "license": "ESRD000739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "11D2003617",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003101245A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Oaks Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Magnolia Oaks Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rucker Holdings Inc
• Tonya Hall Ruffin, MSW
• Rural Urgent Care LLC (MainStreet Family Care)
• Katherine A. Russin, LCSW
• Holdunn Rutkoski, DMD, MPH
• Elaine M Saleh, MD
• Shanicqua Leola Saliu
• Kyle Sanders-Jefferson, NURSE PRACTITIONER
• Jodi O. Santana, LMFT
• Elimelec Santiago, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Hinesville, GA
• Providers in Hinesville, GA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.

Verify at the official NPI Registry.