Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Fort Myers South 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
8850 GLADIOLUS DR, FORT MYERS, FL 33908-5102
(239) 415-1661
(239) 415-7440
Mailing address
5200 VIRGINIA WAY, 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
—
212508100
—
FL
Enumeration date
03/03/2006
Last updated
05/29/2025
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