Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Birmingham East Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1105 E PARK DR, BIRMINGHAM, AL 35235-2560
(205) 833-6003
(205) 836-5157
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
S3705
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1503592
—
LA
05
—
1598738080
—
AL
Enumeration date
02/07/2006
Last updated
11/14/2024
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