Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Loomis Road 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
4120 W LOOMIS RD, GREENFIELD, WI 53221-2052
(414) 761-4920
(414) 761-4926
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
—
1720042559
—
WI
Enumeration date
04/17/2006
Last updated
09/12/2024
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