Organization
DVA WASHINGTON UNIVERSITY HEALTHCARE OF GREATER ST. LOUIS LLC
Active
Other names
DeBaliviere Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
324 DE BALIVIERE AVE, SAINT LOUIS, MO 63112-1804
(314) 367-9111
(314) 367-9248
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200569640A
—
KS
05
—
502928005
—
MO
Enumeration date
04/05/2006
Last updated
06/13/2025
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