Beverly Dialysis LLC

Primary specialty

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

Legal business name

BEVERLY DIALYSIS LLC

Doing business as

Mountaineer Dialysis

Practice address

2958 Robert C Byrd Dr
Beckley, WV 25801-4448

Phone

(304) 252-9183

Fax

(304) 252-9194

NPI assigned

Jan 30, 2013

Last updated

Feb 2, 2024By 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

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mountaineer Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Member of 1

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

• Total Renal Care Inc

  dba TRC Children's Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Chicago, IL
  • NPI 1396704508

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1359504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706832000000",
    "number": "1972841625",
    "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": "615-238-3051",
            "fax_number": "800-246-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2958 ROBERT C BYRD DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258014448",
            "telephone_number": "304-252-9183",
            "fax_number": "304-252-9194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-30",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "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": "3910007007",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountaineer Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountaineer Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John David Berryman, MD
• Bespoken Case Management, LLC
• Best Transports LLC
• Michael Allen Beswick, LICSW
• Diana R Betkijian, PHARM.D.
• Edward Bez, D.O.
• Michelle Bez, PA-C
• Preety Bhatti, MD
• Tina C Bias, CNM
• Angela Biggerstaff

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Beckley, WV
• Providers in Beckley, WV by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; 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.