Organization
DAVITA TIDEWATER - VIRGINIA BEACH, LLC
Active
Other names
Camelot Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1800 CAMELOT DR, STE 100, VIRGINIA BEACH, VA 23454-2440
(757) 481-6879
(757) 496-0187
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
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689605008
—
VA
Enumeration date
07/05/2006
Last updated
05/22/2025
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