NPIMap

Organization Active NPI

Dva Healthcare of Tuscaloosa LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tuscaloosa, AL
National Provider Identifier
1003889171
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
S6301 Issued in AL
Legal business name
DVA HEALTHCARE OF TUSCALOOSA LLC
Doing business as
Tuscaloosa University Dialysis
Practice address
220 15TH St
Tuscaloosa, AL 35401-3523
Phone
(205) 345-6004
Fax
(205) 345-5071
NPI assigned
Feb 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samuel T Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X S6301 AL Primary

Addresses

Primary practice location

220 15TH St
Tuscaloosa, AL 35401-3523

Mailing address

5200 Virginia Way
L & C Department
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
DIA2502DMedicaidAL

Other names 1

  • Tuscaloosa University Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030527000043 AL Part A Provider - End-Stage Renal Disease Facility (ESRD) 2769392166 Practice locations: Tuscaloosa, AL

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Tuscaloosa University DialysisCCN 012502
Overall star rating
2.0 of 5
Ownership
Profit
Certified
Oct 21, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
23

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0301780Tuscaloosa University Dialysis220 15TH Street, Tuscaloosa, AL 35401Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Dva Healthcare of Tuscaloosa LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1003889171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L & C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 15TH ST",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354013523",
            "telephone_number": "205-345-6004",
            "fax_number": "205-345-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE OF TUSCALOOSA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-09",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "AL",
            "license": "S6301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DIA2502D",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tuscaloosa University Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tuscaloosa University Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.