1801850409 NPI number — DVA HEALTHCARE RENAL CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801850409 NPI number — DVA HEALTHCARE RENAL CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DVA HEALTHCARE RENAL CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801850409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 VIRGINIA WAY
Provider Second Line Business Mailing Address:
STE. 400 L&C
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-320-4435
Provider Business Mailing Address Fax Number:
303-209-7821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76086-1536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-599-9570
Provider Business Practice Location Address Fax Number:
817-599-9575
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
USILTON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
GROUP VICE PRESIDENT
Authorized Official Telephone Number:
770-541-7922

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  000072 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com