Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Russellville 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
14897 HIGHWAY 43, RUSSELLVILLE, AL 35653
(256) 332-7044
(256) 332-8959
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
S3001
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DIA2602D
—
AL
Enumeration date
02/09/2006
Last updated
12/30/2025
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