Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Hazelwood Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
637 DUNN RD, STE 125, HAZELWOOD, MO 63042-1757
(314) 731-8039
(314) 731-8084
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
—
505860106
—
MO
05
—
621323060048
—
IL
Enumeration date
03/31/2006
Last updated
07/29/2024
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