Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Hermitage Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
5530 OLD HICKORY BLVD, STE 18, HERMITAGE, TN 37076-2576
(615) 232-2347
(615) 232-7150
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4514
(866) 594-9961
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
85
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0442617
—
TN
05
—
3900076500
—
KY
Enumeration date
04/06/2006
Last updated
08/21/2020
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