Healthcare Provider Details

I. General information

NPI: 1942274493
Provider Name (Legal Business Name): DVA RENAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 N HWY 90 BYP STE 6
SIERRA VISTA AZ
85635-2257
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 520-459-7791
  • Fax: 520-459-7129
Mailing address:
  • Phone: 615-341-6814
  • Fax: 800-293-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberOTC605
License Number StateAZ

VIII. Authorized Official

Name: JOHN WINSTEL
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4501