Organization · Type 2 NPI

Dva Renal Healthcare Inc

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Lakeland, FL

NPI number 1376510487 Active

Practice location

4774 S Florida Ave
Lakeland, FL 33813-2181

Call (863) 646-0462 Map

Fax (863) 647-0802

Mailing address

5200 Virginia Way, L&c Dept
Brentwood, TN 37027-7569

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	None listed

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

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NPI record

NPI: 1376510487
Entity type: Organization (Type 2)
Issued: Mar 7, 2006
Last updated: Mar 12, 2026
Status: Active

Other names

<unavail>
Lakeland South Dialysis · doing business as
Lakeland South Dialysis · doing business as

Authorized official

Samuel Wey
VP, Licensure & Certification
(615) 341-6641

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1376510487

Dva Renal Healthcare Inc's National Provider Identifier is 1376510487, issued on Mar 7, 2006. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Lakeland, FL. The record was last updated on Mar 12, 2026.