DVA HEALTHCARE RENAL CARE INC (NPI# 1629039086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629039086 |
| Entity Type | Organization |
| Organization Name | DVA HEALTHCARE RENAL CARE INC |
| Other Organization Name | LUCEDALE DIALYSIS |
| Practice Address |
652 Manila St Lucedale MS 39452-5962 |
| Mailing Address |
5200 Virginia Way L&c Department Brentwood TN 37027-7569 |
| Practice Telephone | 6019478701 |
| Practice Fax Number | 6019478980 |
| Mailing Telephone | 6153204268 |
| Mailing Fax Number | 8772380567 |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2019-10-22 |
| Authorized Official Name | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
| Authorized Official Telephone | 2537334500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00220525 | 05 |
| Other Name | Type Code |
|---|---|
| Lucedale Dialysis | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831690098 | Dva Healthcare Renal Care Inc | Clinic/Center | 3901 N Roxboro St Ste 108, Durham, NC 27704-2181 | 2018-02-23 |
| 1639695984 | Dva Healthcare Renal Care Inc | Clinic/Center | 209 Nc Highway 111 S, Goldsboro, NC 27534-9253 | 2017-08-18 |
| 1710351531 | Dva Healthcare Renal Care Inc | Clinic/Center | 101 Davita Ln, Elizabeth City, NC 27909-3314 | 2015-11-17 |
| 1851769848 | Dva Healthcare Renal Care Inc | Clinic/Center | 9622 Kincey Ave, Huntersville, NC 28078-9140 | 2015-09-08 |
| 1447643408 | Dva Healthcare Renal Care Inc | Clinic/Center | 1274 Ruin Creek Road, Henderson, NC 27537-4168 | 2015-03-13 |
| 1205116167 | Dva Healthcare Renal Care Inc | Clinic/Center | 11308 Hawthorne Dr, Mint Hill, NC 28227-9300 | 2011-08-24 |
| 1932363744 | Dva Healthcare Renal Care Inc | Clinic/Center | 7260 E Marshville Blvd, Marshville, NC 28103-1191 | 2008-07-11 |
| 1689868739 | Dva Healthcare Renal Care Inc | Clinic/Center | 6620 Old Statesville Rd, Charlotte, NC 28269-6768 | 2007-08-31 |
| 1700815487 | Dva Healthcare Renal Care Inc | Clinic/Center | 3053 State Route 35, Ste 201, Hazlet, NJ 07730-1526 | 2006-07-03 |
| 1508895632 | Dva Healthcare Renal Care Inc | Clinic/Center | 1164 E Route 130, Burlington, NJ 08016-2954 | 2006-07-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | DVA HEALTHCARE RENAL CARE INC. | 2000 16th St, Jld/Secgovfin, Denver, Colorado 80202-5117 |
| Street Address |
652 MANILA ST |
| City | LUCEDALE |
| State | MS |
| Zip Code | 39452-5962 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033420609 | Jennifer K. Walker | Massage Therapist | 352 Oak Street, Lucedale, MS 39452 | 2010-06-29 |
| 1780827543 | David J.conner D.d.s. | Dentist | 17215 Hwy 26, Lucedale, MS 39452 | 2009-04-09 |
| 1285873042 | Rebecca Graves | Nurse Practitioner | 92 W Ratliff St, Lucedale, MS 39452 | 2009-02-18 |
| 1639381791 | George County School District | Registered Nurse | Rocky Creek Elementary, 2183 Rocky Creek Road, Lucedale, MS 39452 | 2007-05-03 |
| 1386856425 | George County School District | Registered Nurse | Central Elementary School, 14159 Hwy 26 West, Lucedale, MS 39452 | 2007-05-03 |
| 1730301961 | George County School District | Registered Nurse | Agricola Elementary School, 6165 Hwy 613, Lucedale, MS 39452 | 2007-05-03 |
| 1932311156 | George County School District | Registered Nurse | Lucedale Elementary School, 689 Church Street, Lucedale, MS 39452 | 2007-05-03 |
| 1295947471 | George County School District | Registered Nurse | George County Middle School, 330 Church Street, Lucedale, MS 39452 | 2007-05-03 |
| 1952522583 | David J. Conner | Dentist | 17215 Highway 26 W, Lucedale, MS 39452 | 2007-05-01 |
| 1225258676 | Keith A Brown | Dentist | 16 Plaza Drive, Lucedale, MS 39452 | 2007-04-26 |
| Find all providers in zip 39452 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
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| 1710411707 | Rcg Mississippi, Inc. | Clinic/Center | 1100 Central Drive, Philadelphia, MS 39350 | 2017-04-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.