Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Lakeland South Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
4774 S FLORIDA AVE, LAKELAND, FL 33813-2181
(863) 646-0462
(863) 647-0802
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
—
890032900
—
FL
Enumeration date
03/07/2006
Last updated
03/12/2026
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