Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Dyersburg Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
1575 PARR AVE, DYERSBURG, TN 38024-3151
(731) 286-5184
(731) 286-0174
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4514
(866) 594-9961
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
44
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00220633
—
MS
05
—
0442533
—
TN
05
—
202308359
—
MO
05
—
3900010400
—
KY
05
—
505217604
—
MO
Enumeration date
04/06/2006
Last updated
02/17/2021
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