Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Taylorville 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
901 W SPRESSER ST, TAYLORVILLE, IL 62568-1831
(217) 824-5460
(217) 824-5967
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
—
=========
—
IL
Enumeration date
03/17/2006
Last updated
11/03/2025
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