Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Oklahoma City 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
319 SW 59TH ST, OKLAHOMA CITY, OK 73109-8301
(405) 634-3708
(405) 636-1211
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
—
100757220B
—
OK
Enumeration date
04/03/2006
Last updated
12/19/2024
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