ALTERRA DIALYSIS LLC NPI 1568993947

NPI Information

NPI: 1568993947
Provider Name: ALTERRA DIALYSIS LLC
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Doing Business As: PORT ORANGE DIALYSIS
CLIA Number: 10D2138180
Address: 3997 S NOVA RD
RIVERWOOD PLAZA
PORT ORANGE, FL
ZIP 32127
Phone: (386) 761-7961

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NPI Details

ALTERRA DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Port Orange, FL. ALTERRA DIALYSIS LLC NPI is 1568993947. The provider is registered as an organization entity type.
The provider Is Doing Business As Port Orange Dialysis.

The provider's business location address is:

3997 S NOVA RD
RIVERWOOD PLAZA
PORT ORANGE, FL
ZIP 32127-296
Phone: (386) 761-7961
Fax: (386) 763-2150

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 10D2138180 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/27/2017 and was last updated on 8/12/2024.

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
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment		FLORIDA	Yes

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
1	10047330	MEDICAID	FLORIDA

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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