Dva Renal Healthcare Inc
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Lake Charles, LA
NPI 1154380228 · NPPES record last updated Jan 27, 2026
Key facts
- NPI
- 1154380228
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 060 (LA)
- Legal business name
- DVA RENAL HEALTHCARE INC
- Practice address
- 300 18TH St
Lake Charles, LA 70601-7342 - Phone
- (337) 433-6831
- Fax
- (337) 433-6613
- NPI assigned
- Mar 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Samuel T Wey
- Title
- VP, Licensure & Certification
- Phone
- (615) 341-6641
Affiliated clinicians 2
-
Asif Nisar, MD
Medicare Care Compare: Dialysis facility
- Listed as
- DaVita Lake Charles Southwest Dialysis
- Overall star rating
- ★★☆☆☆ 2.0 of 5
- Ownership
- Profit
- Certified
- Mar 11, 1996
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 17
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D0915936 | Lake Charles Southwest Dialysis | Certificate of waiver | Jun 10, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030321000040 | LA | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 0840107611 | Practice locations: Lake Charles, LA |
National Provider Directory
- Tax ID family
- Gambro Healthcare Anahe
Locations
300 18th St
Lake Charles, LA 70601
Phone (337) 433-6831
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 060 | LA | Yes |
Addresses
Primary practice location
300 18TH St
Lake Charles, LA 70601-7342
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1102121 | Medicaid | LA |
Other names
- Lake Charles Southwest Dialysis
Other providers in Lake Charles, LA
- Ronald Scott Duplechin
- Calli Janet Dupont
- Clint Dupre
- Aaron L Dupree
- Alisha Danielle Dupree
- Dva Renal Healthcare Inc
- Dyer Psychiatric Services
- Michelle Trahan Dyer
- Syd Dyer
- Dynamic Orthotic Services, Inc.
All providers in Lake Charles, LA · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.