Organization
REVINO DIALYSIS, LLC
Active
Parent organization
DAVITA INC
Other names
Fort Pierce Kidney Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
DAVITA INC
Authorized official
SAMUEL T. WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2000 HARTMAN RD STE 2, FORT PIERCE, FL 34947-4413
(772) 467-1117
(772) 595-9340
Mailing address
5200 VIRGINIA WAY, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
07/14/2022
Last updated
04/24/2024
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