Dva Healthcare Renal Care Inc

Primary specialty

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

License

ERD-0059 Issued in SC

Legal business name

DVA HEALTHCARE RENAL CARE INC

Doing business as

Allendale County Dialysis

Practice address

1241 Boundary St W
Fairfax, SC 29827-3611

Phone

(803) 632-1587

Fax

(803) 632-1611

NPI assigned

Apr 4, 2006

Last updated

May 18, 2026By 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

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Allendale County Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Listed as

DaVita Allendale County DialysisCCN 422557

Overall star rating

2.0 of 5

Ownership

Profit

Certified

Nov 3, 1995

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

21

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

CLIA laboratory certificates

Tax ID family

Community Dialysis Services194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 8

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Columbia Central

  dba Central Columbia

  • Point of Service
  • Columbia, SC
  • NPI 1932305497
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba North Orangeburg Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Orangeburg, SC
  • NPI 1093777146
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Santee Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Santee, SC
  • NPI 1164484234
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Walterboro Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Walterboro, SC
  • NPI 1467414482
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Aiken Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Aiken, SC
  • NPI 1477515575
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Lancaster SC Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Lancaster, SC
  • NPI 1578525614
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Central Bamberg Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Bamberg, SC
  • NPI 1639131741
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Greenwood Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Greenwood, SC
  • NPI 1710949847
  NPD tax ID

Member of 1

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

• Dva Renal Healthcare Inc

  dba Florissant Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1740241454

  Member Of

  NPD member

Locations

Affiliated clinicians 1

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

• Sanjay Kumar, MD

  • Internal Medicine Physician
  • Walterboro, SC
  • NPI 1275632309

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1073575171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 BOUNDARY ST W",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298273611",
            "telephone_number": "803-632-1587",
            "fax_number": "803-632-1611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "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": "SC",
            "license": "ERD-0059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425570",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000855709M",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allendale County Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Allendale County Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Edward Byrne, MD
• Sotheary Chan, PA
• Delois Daniels, APRN
• Cindy Davis, R.N.
• Lisa Davis, DNP, APRN, FNP-C
• Vivien Rose Ebert, DMD
• Fairfax Pharmacy Inc.
• Fairfax Pharmacy Inc.
• Jerlesa Frazier-Harney, RN
• Christopher Michael Gamboa, MD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fairfax, SC
• Providers in Fairfax, SC by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.