Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Wyandotte West Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
11014 HASKELL AVE, KANSAS CITY, KS 66109-4404
(913) 721-9780
(913) 721-9818
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
—
100213850N
—
KS
05
—
505217406
—
MO
05
—
946155373A
—
GA
Enumeration date
03/20/2006
Last updated
05/23/2024
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