TYLER DIALYSIS LLC NPI 1215287941

NPI Information

  • NPI: 1215287941
  • Provider Name: TYLER DIALYSIS LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: LOURDES INNOVA DIALYSIS
  • CLIA Number: 31D1098366
  • Address: 3716 CHURCH RD
    MOUNT LAUREL, NJ
    ZIP 08054
  • Phone: (856) 222-0386

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NPI Details

TYLER DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Mount Laurel, NJ. TYLER DIALYSIS LLC NPI is 1215287941. The provider is registered as an organization entity type.
The provider Is Doing Business As Lourdes Innova Dialysis.

The provider's business location address is:

3716 CHURCH RD
MOUNT LAUREL, NJ
ZIP 08054-104
Phone: (856) 222-0386
Fax: (856) 235-0592

The provider's authorized official is Samuel 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 31D1098366 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/10/2012 and was last updated on 10/19/2023.

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) Treatment24255NEW JERSEYYes

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
10318213MEDICAIDNEW JERSEY

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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