Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Wilson 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
2833 WOOTEN BOULEVARD SW, WILSON, NC 27893-8625
(252) 206-1471
(252) 206-7157
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3422507
—
NC
Enumeration date
03/24/2006
Last updated
07/23/2025
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