Organization
DVA HEALTHCARE SOUTHWEST OHIO LLC
Active
Other names
Fairfield 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
1210 HICKS BLVD, FAIRFIELD, OH 45014-1921
(513) 939-1110
(513) 939-1202
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 238-3051
(800) 246-8346
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0491DC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3900031000
—
KY
Enumeration date
04/13/2006
Last updated
11/07/2023
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