Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Jacksonville 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
1515 W WALNUT ST, JACKSONVILLE, IL 62650-1150
(217) 243-3042
(217) 243-1365
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
03/17/2006
Last updated
10/04/2024
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