Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Woodburn 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
1840 NEWBERG HWY, STE 140, WOODBURN, OR 97071-3187
(503) 982-2005
(503) 982-2561
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
170048
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133038
—
OR
Enumeration date
04/04/2006
Last updated
08/29/2024
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