CLEBURNE DIALYSIS LLC NPI 1942554407

NPI Information

  • NPI: 1942554407
  • Provider Name: CLEBURNE DIALYSIS LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: CORAL HILLS DIALYSIS
  • CLIA Number: 21D2066239
  • Address: 4797 MARLBORO PIKE
    CAPITOL HEIGHTS, MD
    ZIP 20743
  • Phone: (301) 420-1513

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NPI Details

CLEBURNE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Capitol Heights, MD. CLEBURNE DIALYSIS LLC NPI is 1942554407. The provider is registered as an organization entity type.
The provider Is Doing Business As Coral Hills Dialysis.

The provider's business location address is:

4797 MARLBORO PIKE
CAPITOL HEIGHTS, MD
ZIP 20743-213
Phone: (301) 420-1513
Fax: (301) 420-3912

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 21D2066239 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/6/2012 and was last updated on 10/31/2023.

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) TreatmentE2683MARYLANDYes

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
1422880400MEDICAIDMARYLAND

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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