Organization · Type 2 NPI

Wallowa Dialysis LLC

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Ontario, OH

NPI number 1023360955 Active

Practice location

2148 W 4th St
Ontario, OH 44906-1200

Call (419) 747-4039 Map

Fax (419) 747-4046

Mailing address

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

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	None listed

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

NPI record

NPI: 1023360955
Entity type: Organization (Type 2)
Issued: Oct 2, 2012
Last updated: Sep 15, 2025
Status: Active

Other names

<unavail>
Mid Ohio Dialysis · doing business as
Mid Ohio Dialysis · doing business as

Authorized official

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

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1023360955

Wallowa Dialysis LLC's National Provider Identifier is 1023360955, issued on Oct 2, 2012. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Ontario, OH. The record was last updated on Sep 15, 2025.