Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Memphis South Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (SR DIRECTOR LICENSURE&CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1205 MARLIN RD, MEMPHIS, TN 38116-5812
(901) 346-6637
(901) 346-7884
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, 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
136
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0442649
—
TN
05
—
05820307
—
MS
05
—
152749734
—
AR
05
—
202575213
—
MD
05
—
202575213
—
MO
05
—
500431309
—
MO
Enumeration date
04/07/2006
Last updated
10/05/2023
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