Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Cookeville Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
320 N WILLOW AVE, COOKEVILLE, TN 38501-2337
(931) 520-7763
(931) 646-4866
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
110
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0442511
—
TN
05
—
3900013800
—
KY
Enumeration date
04/06/2006
Last updated
04/28/2025
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