Organization · Type 2 NPI

Dva Renal Healthcare Inc

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Greenfield, WI

NPI number 1720042559 Active

Practice location

4120 W Loomis Rd
Greenfield, WI 53221-2052

Call (414) 761-4920 Map

Fax (414) 761-4926

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: 1720042559
Entity type: Organization (Type 2)
Issued: Apr 17, 2006
Last updated: Sep 12, 2024
Status: Active

Other names

<unavail>
Loomis Road Dialysis · doing business as
Loomis Road Dialysis · doing business as

Authorized official

Samuel T 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 1720042559

Dva Renal Healthcare Inc's National Provider Identifier is 1720042559, issued on Apr 17, 2006. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Greenfield, WI. The record was last updated on Sep 12, 2024.