Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Lake St Louis Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (SR DIRECTOR LICENSURE&CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
200 BREVCO PLZ STE 201, LAKE ST LOUIS, MO 63367
(636) 561-4799
(636) 561-4533
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6264
(800) 297-2925
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
—
501537849
—
MO
Enumeration date
03/31/2006
Last updated
08/22/2023
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