Healthcare Provider Details

I. General information

NPI: 1457313231
Provider Name (Legal Business Name): DVA HEALTHCARE OF PENNSYLVANIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 STEUBENVILLE PIKE
PARIS PA
15021-8529
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 724-729-3350
  • Fax: 724-729-3353
Mailing address:
  • Phone: 615-341-6410
  • Fax: 888-662-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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