Organization · Type 2 NPI

Bullock Dialysis LLC

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

NPI number 1639715808 Active

Practice location

2290 Ferguson Rd
Cincinnati, OH 45238

Call (513) 347-3626 Map

Fax (513) 347-2680

Mailing address

5200 Virginia Way, Att: 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...

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NPI record

NPI: 1639715808
Entity type: Organization (Type 2)
Issued: Nov 22, 2019
Last updated: Sep 3, 2025
Status: Active
Subpart: Yes of Davita Inc

Other names

<unavail>
Queen City Dialysis · doing business as
Queen City Dialysis · doing business as

Authorized official

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

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About NPI 1639715808

Bullock Dialysis LLC's National Provider Identifier is 1639715808, issued on Nov 22, 2019. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Cincinnati, OH. The record was last updated on Sep 3, 2025.