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FAYETTEVILLE DIALYSIS
NPI 1811315971
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Tacoma, WA

Active since April 04, 2014CLIA 04D0922946 · Waiver
1423 PACIFIC AVE, TACOMA, WA 98402(253) 382-1752 Get Directions Write a Review

NPPES record last updated: April 4, 2014. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Fayetteville Dialysis NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAYETTEVILLE DIALYSIS (NPI 1811315971) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Tacoma, Washington and active in the NPI registry since April 2014. The organization holds a CLIA Waiver certificate valid through December 9, 2026 and lists Kent Thiry, Ceo, as its authorized official.

NPPES Registry Identity

NPI1811315971
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameFAYETTEVILLE DIALYSIS
Location Address1423 PACIFIC AVETacoma, WA 98402-4203
Mailing Address509 E Millsap Rd, Ste 111Fayetteville, AR 72703-4067 · (479) 443-6688
Phone(253) 382-1752
Organization SubpartNo
Authorized OfficialKent ThiryCeo · (303) 876-6000
Enumeration DateApril 4, 2014
✔ NPI 1811315971 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
Licenses✔ Licensed in AR · 04D0922946✔ Licensed in AR · 1295913416
1423 PACIFIC AVE, Tacoma, WA 98402
Open in Google Maps ↗

Other Identifiers 1

Medicaid168261134AR

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 04D0922946

Fayetteville Dialysis · Fayetteville, AR
Active · expires Dec 9, 2026
CLIA Number04D0922946
Laboratory TypeEnd Stage Renal Disease Dialysis Facility
Certificate Effective DateDecember 10, 2024
Certificate Expiration DateDecember 9, 2026
Laboratory DirectorShamsul L. Alam
Laboratory Phone(479) 443-6688
Laboratory LocationFayetteville Dialysis509 E Millsap Rd, Ste 111, Fayetteville, AR 72703
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CAPES DIALYSIS LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1423 PACIFIC AVE
TACOMA, WA 98402
Pierce County (253) 382-1752
BRADLEY COUNTY DIALYSIS
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1423 PACIFIC AVE
TACOMA, WA 98402
Pierce County (253) 382-1752
MENA DIALYSIS
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1423 PACIFIC AVE
TACOMA, WA 98402
Pierce County (253) 382-1752
CAPES DIALYSIS LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1423 PACIFIC AVE
TACOMA, WA 98402
Pierce County (253) 382-1752
MALVERN DIALYSIS
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1423 PACIFIC AVE
TACOMA, WA 98402
Pierce County (253) 382-1752
NORTH LITTLE ROCK DIALYSIS
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1423 PACIFIC AVE
TACOMA, WA 98402
Pierce County (253) 382-1752
OSCEOLA DIALYSIS
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1423 PACIFIC AVE
TACOMA, WA 98402
Pierce County (253) 382-1752
CAPES DIALYSIS LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1423 PACIFIC AVE
TACOMA, WA 98402
Pierce County (253) 382-1752

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fayetteville Dialysis's NPI number?

The NPI number for Fayetteville Dialysis is 1811315971. It was assigned to this organization in the NPPES registry on April 4, 2014.

Where is Fayetteville Dialysis located?

Fayetteville Dialysis is located at 1423 Pacific Ave, Tacoma, WA 98402. The listed phone number is (253) 382-1752.

What is Fayetteville Dialysis's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Does Fayetteville Dialysis hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 04D0922946) is associated with this NPI, valid through December 9, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fayetteville Dialysis was last updated on April 4, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.