Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Lucedale Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
652 MANILA ST, LUCEDALE, MS 39452-5962
(601) 947-8701
(601) 947-8980
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00220525
—
MS
Enumeration date
03/28/2006
Last updated
11/10/2025
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