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NPI Code Detail

MEDICARE: DVA HEALTHCARE OF NORWICH LLC

MEDICARE: DVA HEALTHCARE OF NORWICH LLC
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center0279CT

Other Identifiers

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

General Provider Information

NPI Number : 1255307039
Entity Type Code : Organization
Provider Name (Legal Business Name) : DVA HEALTHCARE OF NORWICH LLC
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 : 113 SALEM TPKE STE 4
Second Line :
City : NORWICH
State : CT
Zip : 06360-6484
Country : US
Telephone Number : 860-800-6388
Fax Number : 860-800-6425
Authorized Official
Title or Position : VP, LICENSURE & CERTIFICATION
Name : SAMUEL T. WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 02/23/2006
Last Update Date : 11/13/2024

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Directions to “DVA HEALTHCARE OF NORWICH LLC ” Practice Location

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