NPIMap

Organization Active NPI

Renal Treatment Centers Mid Atlantic Inc

Doing business as Shamokin Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Coal Township, PA
National Provider Identifier
1750906574
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
RENAL TREATMENT CENTERS MID ATLANTIC INC
Doing business as
Shamokin Dialysis
Practice address
9333 State Route 61
Ste 1
Coal Township, PA 17866-4170
Phone
(570) 500-7072
Fax
(570) 500-7090
NPI assigned
Jun 9, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Addresses

Primary practice location

9333 State Route 61
Ste 1
Coal Township, PA 17866-4170

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
103444602MedicaidPA

Other names 1

  • Shamokin Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200910001030 PA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4587572383 Practice locations: Coal Township, PA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Shamokin DialysisCCN 732502
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Oct 23, 2020
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
12

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
39D2185275Shamokin Dialysis9333 State Route 61, Coal Township, PA 17866Certificate of waiverJun 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Renal Treatment Centers Mid Atlantic Inc80 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1591660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1750906574",
    "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": "9333 STATE ROUTE 61",
            "address_2": "STE 1",
            "city": "COAL TOWNSHIP",
            "state": "PA",
            "postal_code": "178664170",
            "telephone_number": "570-500-7072",
            "fax_number": "570-500-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS MID ATLANTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-09",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103444602",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shamokin Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shamokin Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coal Township, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; 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.