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NPI Code Detail

MEDICARE: DVA RENAL HEALTHCARE INC

MEDICARE: DVA RENAL HEALTHCARE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center080000705CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093780017
Entity Type Code : Organization
Provider Name (Legal Business Name) : DVA RENAL HEALTHCARE INC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : L&C DEPT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number : 615-238-3085
Fax Number : 800-268-9682
Provider Business Practice Location Address
First Line : 995 GATEWAY CENTER WAY
Second Line : STE 101
City : SAN DIEGO
State : CA
Zip : 92102-4550
Country : US
Telephone Number : 619-262-1960
Fax Number : 619-262-2420
Authorized Official
Title or Position : VP, LICENSURE & CERTIFICATION
Name : SAMUEL T. WEY SR.
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 02/22/2006
Last Update Date : 01/16/2024

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Directions to “DVA RENAL HEALTHCARE INC ” Practice Location

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