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NPI Code Detail

MEDICARE: DVA HEALTHCARE RENAL CARE INC

MEDICARE: DVA HEALTHCARE RENAL CARE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/CenterCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801860176
Entity Type Code : Organization
Provider Name (Legal Business Name) : DVA HEALTHCARE RENAL CARE INC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : STE 400
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number : 615-320-4435
Fax Number : 303-209-7821
Provider Business Practice Location Address
First Line : 10690 SAN PABLO AVE
Second Line :
City : EL CERRITO
State : CA
Zip : 94530-2620
Country : US
Telephone Number : 510-528-9590
Fax Number : 510-528-9803
Authorized Official
Title or Position : GROUP VICE PRESIDENT
Name : THOMAS O USILTON JR.
Credential :
Telephone Number : 770-541-7922
Provider Enumeration Date : 02/14/2006
Last Update Date : 08/14/2007

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Directions to “DVA HEALTHCARE RENAL CARE INC ” Practice Location

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