MEDICARE: DVA HEALTHCARE RENAL CARE, 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1154399491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DVA HEALTHCARE RENAL CARE, 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5857 W TENNESSEE ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-9218
Country	:	US
Telephone Number	:	850-350-0002
Fax Number	:	850-350-0120

Authorized Official
Title or Position	:	VP, LICENSURE & CERTIFICATION
Name	:	SAMUEL T. WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	02/14/2025

Similar Medicare Providers

1609875160 — TALLAHASSEE DEVELOPMENTAL CENTER
Practice Location Address:

455 APPLEYARD DR
TALLAHASSEE, FL
32304-2808

Practice Phone: 850-575-0619
Practice Fax: 850-576-5773

1194714220 — DR. CHRISTOPHER BURNETTE KING O.D.
Practice Location Address:

4400 W TENNESSEE ST
TALLAHASSEE, FL
32304-1029

Practice Phone: 850-574-6113
Practice Fax:

1174509913 — MR. THEODORE ROOSEVELT HOUSTON
Practice Location Address:

855 W TENNESSEE ST , THAGARD HEALTH CENTER, FLORIDA STATE UNIVERSITY
TALLAHASSEE, FL
32304-7834

Practice Phone: 850-644-1015
Practice Fax: 850-654-5570

1700853611 — RONALD J HOFFMAN DCPA
Practice Location Address:

1224 OCALA RD
TALLAHASSEE, FL
32304-1548

Practice Phone: 850-576-2129
Practice Fax: 850-576-9602

1013979160 — FRANK ANDREW KOZEL MD MSCR
Practice Location Address:

1115 W CALL ST
TALLAHASSEE, FL
32304-3556

Practice Phone: 850-644-1855
Practice Fax:

1487619391 — DISC VILLAGE, INC.
Practice Location Address:

3333 W PENSACOLA ST
TALLAHASSEE, FL
32304-2888

Practice Phone: 850-575-4388
Practice Fax: 850-576-3317

Directions to “DVA HEALTHCARE RENAL CARE, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.