Tennessee Valley Dialysis Center LLC

Primary specialty

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

Legal business name

TENNESSEE VALLEY DIALYSIS CENTER LLC

Doing business as

Tennessee Valley Dialysis Center

Practice address

107 Woodlawn Dr
Ste 2
Johnson City, TN 37604-6287

Phone

(423) 926-2976

Fax

(423) 926-1232

NPI assigned

May 24, 2006

Last updated

Nov 28, 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

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tennessee Valley Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

DaVita Tennessee Valley Dialysis CenterCCN 442666

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Jan 31, 2007

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

16

Member of 1

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

Locations

Affiliated clinicians 2

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

• Lara Wahib Kfoury, MD

  • Nephrology Physician
  • Johnson City, TN
  • NPI 1700074416

  Dialysis facility

  Care Compare affiliation Name & address match
• Martin Quan Tran, DO

  • Nephrology Physician
  • Johnson City, TN
  • NPI 1851395891

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701129600000",
    "number": "1902851033",
    "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": "615-320-4514",
            "fax_number": "866-594-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WOODLAWN DR",
            "address_2": "STE 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046287",
            "telephone_number": "423-926-2976",
            "fax_number": "423-926-1232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE VALLEY DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0442666",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tennessee Valley Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tennessee Valley Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Tennessee Valley Anesthesia Associates, LLC
• Chenna Reddy Tera
• William Jefferson Terry Jr., MD
• Heather Marie Tester, RDA
• Jenny Marie Tester
• Jessica Lea Tester, RN

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Johnson City, TN
• Providers in Johnson City, TN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.