Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
North Orangeburg Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(012) 061-5203
Entity
Organization
Contact information
Practice address
124 FIRE TOWER RD, ORANGEBURG, SC 29118-1401
(803) 531-6202
(803) 534-5263
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
(615) 320-4593
(800) 293-5872
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ERD-0023
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01808319
—
NY
05
—
422508
—
SC
Enumeration date
04/04/2006
Last updated
01/25/2024
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