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NPI Code Detail

MEDICARE: DVA RENAL HEALTHCARE INC

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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

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 : 1821058900
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 DEPT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number : 615-320-4593
Fax Number : 800-293-5872
Provider Business Practice Location Address
First Line : 1704 WAYNE MEMORIAL DR
Second Line :
City : GOLDSBORO
State : NC
Zip : 27534-2240
Country : US
Telephone Number : 919-739-6505
Fax Number : 919-739-6506
Authorized Official
Title or Position : VP LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 03/24/2006
Last Update Date : 01/30/2024

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Directions to “DVA RENAL HEALTHCARE INC ” Practice Location

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