Dva Renal Healthcare Inc

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

300121 Issued in KY

Legal business name

DVA RENAL HEALTHCARE INC

Doing business as

South Hill Dialysis

Practice address

525 Alexandria Pike
Ste 120
Southgate, KY 41071-3243

Phone

(859) 442-5539

Fax

(859) 442-5587

NPI assigned

Apr 10, 2006

Last updated

Oct 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel T Wey

Title

Authorized Official

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• South Hill Dialysis Doing business as

Member of 1

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

• Dva Renal Healthcare Inc

  dba Nashville Home Training Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Nashville, TN
  • NPI 1295983245

  Member Of

  NPD member

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698364800000",
    "number": "1013970110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-238-3051",
            "fax_number": "800-246-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 ALEXANDRIA PIKE",
            "address_2": "STE 120",
            "city": "SOUTHGATE",
            "state": "KY",
            "postal_code": "410713243",
            "telephone_number": "859-442-5539",
            "fax_number": "859-442-5587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "KY",
            "license": "300121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3900020300",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2121457",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Hill Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Hill Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cincinnati Health Care Group PSC
• Penne Clos
• Alexandra Rene Daniels, MA, BCBA, LBA, COBA
• DRS Cullen & Kreilein, PSC, Inc.
• Ronald Lee Durrett, CPO
• Erin Elfers, M.ED, BCBA
• Matthew Enzweiler, DPM
• Kassandra Nicole Hall, PA-C
• Caron E Harner, DPM
• Quintin Hauser

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Southgate, KY
• Providers in Southgate, KY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.