Dva Renal Healthcare Inc
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Southgate, KY
NPI 1013970110 · NPPES record last updated Oct 27, 2023
Key facts
- NPI
- 1013970110
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 300121 (KY)
- Legal business name
- DVA RENAL HEALTHCARE INC
- Practice address
- 525 Alexandria Pike
Ste 120
Southgate, KY 41071-3243 - Phone
- (859) 442-5539
- Fax
- (859) 442-5587
- NPI assigned
- Apr 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Samuel T Wey
- Title
- Authorized Official
- Phone
- (253) 733-4501
Member of 1
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 300121 | KY | Yes |
Addresses
Primary practice location
525 Alexandria Pike
Ste 120
Southgate, KY 41071-3243
Mailing address
5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569
Phone (615) 238-3051
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2121457 | Medicaid | OH | |
| 3900020300 | Medicaid | KY |
Other names
- South Hill Dialysis
Other providers in Southgate, KY
- Cincinnati Health Care Group PSC
- Penne Clos
- Alexandra Rene Daniels
- DRS Cullen & Kreilein, PSC, Inc.
- Ronald Lee Durrett
- Erin Elfers
- Matthew Enzweiler
- Kassandra Nicole Hall
- Caron E Harner
- Quintin Hauser
All providers in Southgate, KY · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.