Organization
DVA HEALTHCARE OF PENNSYLVANIA LLC
Active
Other names
Philadelphia 42nd Street Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
4126 WALNUT ST, PHILADELPHIA, PA 19104-3511
(215) 387-0500
(215) 387-6414
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
—
1007451930021
—
PA
Enumeration date
04/08/2006
Last updated
01/15/2026
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