Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Brandon East 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
114 E BRANDON BLVD, BRANDON, FL 33511-5219
(813) 657-2783
(813) 657-2521
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
—
890068000
—
FL
Enumeration date
03/02/2006
Last updated
11/08/2024
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