Organization
DVA HEALTHCARE OF TUSCALOOSA LLC
Active
Other names
Fayette 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
2450 TEMPLE AVE N, FAYETTE, AL 35555-1160
(205) 932-8500
(205) 932-8332
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
S2901
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00220640
OUT OF STATE PROVIDER
MS
05
—
DIA2548D
—
AL
Enumeration date
02/08/2006
Last updated
02/21/2024
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