Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Pageland 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
505A S PEARL ST, PAGELAND, SC 29728-2222
(843) 672-3491
(843) 672-3504
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
ERD-0160
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4202592
—
NC
05
—
ERD134
—
SC
Enumeration date
04/04/2006
Last updated
10/23/2024
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