Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Northport 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
400 MCFARLAND BLVD STE B-2, NORTHPORT, AL 35476-3371
(659) 239-6174
(659) 239-6190
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
S6303
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DIA2570D
—
AL
Enumeration date
02/08/2006
Last updated
08/28/2025
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