Healthcare Provider Details

I. General information

NPI: 1083673990
Provider Name (Legal Business Name): DVA HEALTHCARE OF MASSACHUSETTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 LIBBEY INDUSTRIAL PKWY STE 900
WEYMOUTH MA
02189-3122
US

IV. Provider business mailing address

5200 VIRGINIA WAY L & C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-7700
  • Fax: 781-331-3046
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMUEL T WEY
Title or Position: VP LICENSURE & CERTIFICATION
Credential:
Phone: 615-341-6641