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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	007308	TX

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

General Provider Information

NPI Number	:	1235193905
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 DEPARTMENT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-341-6764
Fax Number	:	833-781-6999

Provider Business Practice Location Address
First Line	:	1335 LA CONCHA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1809
Country	:	US
Telephone Number	:	713-794-0600
Fax Number	:	713-794-0999

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JOHN WINSTEL JR.
Credential	:
Telephone Number	:	253-733-4501

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	03/11/2021

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Directions to “DVA RENAL HEALTHCARE INC ” Practice Location

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