Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
South Orangeburg Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (SR DIRECTOR,LICENSURE&CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1080 SUMMERS AVE, ORANGEBURG, SC 29115-4920
(803) 539-0084
(803) 539-0097
Mailing address
5200 VIRGINIA WAY, L&C DEPT, 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-0083
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425650
—
SC
Enumeration date
04/05/2006
Last updated
08/17/2023
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