LATROBE DIALYSIS LLC NPI 1184994576

NPI Information

  • NPI: 1184994576
  • Provider Name: LATROBE DIALYSIS LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: TN SMOKIE MOUNTAIN DIALYSIS
  • CLIA Number: 44D1046353
  • Address: 2320 KNOB CREEK RD STE 408
    JOHNSON CITY, TN
    ZIP 37604
  • Phone: (423) 232-1969

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NPI Details

LATROBE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Johnson City, TN. LATROBE DIALYSIS LLC NPI is 1184994576. The provider is registered as an organization entity type.
The provider Is Doing Business As Tn Smokie Mountain Dialysis.

The provider's business location address is:

2320 KNOB CREEK RD STE 408
JOHNSON CITY, TN
ZIP 37604-581
Phone: (423) 232-1969
Fax: (423) 232-0320

The provider's authorized official is Samuel T Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 44D1046353 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/3/2012 and was last updated on 3/11/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment158TENNESSEEYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10442668MEDICAIDTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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