Dva Healthcare Renal Care, Inc.

Primary specialty

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

Legal business name

DVA HEALTHCARE RENAL CARE, INC.

Practice address

821 Lincoln Hwy
Fairview Heights, IL 62208-2216

Phone

(618) 632-9550

Fax

(618) 632-8903

NPI assigned

Mar 17, 2006

Organization subpart

No

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

Authorized official

Name

Thomas O Usilton Jr.

Title

Group Vice President

Phone

(770) 541-7922

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fairview Heights Dialysis Doing business as

Tax ID family

CDS of Zephyrhills194 organizations share this tax ID, including this one

Locations

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013986389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "STE 400 L&C",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4435",
            "fax_number": "303-209-7821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 LINCOLN HWY",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082216",
            "telephone_number": "618-632-9550",
            "fax_number": "618-632-8903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "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",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2300521",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairview Heights Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Douglas
• Alex Charles Dow, PHARMD
• Ashley Duffie, QMHP, MA
• Bayleigh Durham, RBT
• Kaitlin Brooke Duross, BHS, DPT
• Alexis Dykes
• Rachel Edgerly, MT-BC
• Chyriah Edwards
• Deborah Kaye Edwards, PLPC
• Tomika Eiland, LCSW

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fairview Heights, IL
• Providers in Fairview Heights, IL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.