Organization · Type 2 NPI

Ponca Dialysis LLC

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · San Jose, CA

NPI number 1538400239 Active

Practice location

1290 Tully Rd, Ste 60
San Jose, CA 95122-3069

Call (408) 275-0105 Map

Fax (408) 275-0115

Mailing address

5200 Virginia Way, L&c Dept
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...

Another provider at this address

Total Renal Care IncEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center San Jose, CA NPI 1154668184

Other end-stage renal disease (esrd) treatment clinic/center providers in San Jose

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NPI record

NPI: 1538400239
Entity type: Organization (Type 2)
Issued: Mar 6, 2013
Last updated: Mar 29, 2024
Status: Active

Other names

<unavail>
Tully Road Home Training · doing business as
Tully Road Home Training · doing business as

Authorized official

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

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About NPI 1538400239

Ponca Dialysis LLC's National Provider Identifier is 1538400239, issued on Mar 6, 2013. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in San Jose, CA. The record was last updated on Mar 29, 2024.