Dva Renal Healthcare Inc

Primary specialty

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

License

0497DC Issued in OH

Legal business name

DVA RENAL HEALTHCARE INC

Practice address

1210 Hicks Blvd
Fairfield, OH 45014-1921

Phone

(513) 939-1120

Fax

(513) 939-1150

NPI assigned

Apr 13, 2006

Organization subpart

No

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

Authorized official

Name

James K Hilger

Title

Chief Accounting Officer

Phone

(253) 733-4500

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Fairfield Home Training Dialysis Doing business as

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

CLIA laboratory certificates

Member of 1

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

• Dva Renal Healthcare Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pageland, SC
  • NPI 1548222615

  Member Of

  NPD member

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568764800000",
    "number": "1184688459",
    "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",
            "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": "1210 HICKS BLVD",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450141921",
            "telephone_number": "513-939-1120",
            "fax_number": "513-939-1150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2019-09-18",
        "status": "A",
        "authorized_official_last_name": "HILGER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4500"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "OH",
            "license": "0497DC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2220279",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3900037700",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairfield Home Training Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fairfield Home Training Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tamara Augustine Duclaire, M.D.
• Shelby Eileen Duncan, LSW
• Matthew Dupont, PA-C
• Karen Durgans, LPCC
• Dva Healthcare Southwest Ohio LLC
• Lamonda D Dye, LPN
• Dymphna Mental Health Services LLC
• Dynamic Care Assistance, LLC
• Dynamic Telehealth LLC
• Charles William Eastlick, LICDC, LPC, M.ED.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fairfield, OH
• Providers in Fairfield, OH by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.