Organization
DVA RENAL HEALTHCARE INC
Active
Other names
South Hill Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (AUTHORIZED OFFICIAL)
(253) 733-4501
Entity
Organization
Contact information
Practice address
525 ALEXANDRIA PIKE, STE 120, SOUTHGATE, KY 41071-3243
(859) 442-5539
(859) 442-5587
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 238-3051
(800) 246-8346
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
300121
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2121457
—
OH
05
—
3900020300
—
KY
Enumeration date
04/10/2006
Last updated
10/27/2023
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