Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Roseburg Mercy 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
2410 NW EDENBOWER BLVD, STE 178, ROSEBURG, OR 97471-8830
(541) 672-4608
(541) 672-4817
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
170049
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133772
—
OR
Enumeration date
04/04/2006
Last updated
09/16/2025
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