Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Council Bluffs Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
300 W BROADWAY STE 150, COUNCIL BLUFFS, IA 51503-9077
(712) 388-0261
(712) 388-0269
Mailing address
5200 VIRGINIA WAY, ATT: 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
—
1811171440
—
IA
05
—
=========
—
NE
Enumeration date
12/18/2007
Last updated
11/07/2024
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