Dva Renal Healthcare Inc
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Baxley, GA
NPI 1316916356 · NPPES record last updated May 30, 2024
Key facts
- NPI
- 1316916356
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- ESRD001055 (GA)
- Legal business name
- DVA RENAL HEALTHCARE INC
- Practice address
- 539 Fair St
Baxley, GA 31513-0112 - Phone
- (912) 366-0202
- Fax
- (912) 366-0333
- NPI assigned
- Mar 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Samuel Wey, AO
- Title
- VP, Licensure & Certification
- Phone
- (615) 341-6641
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 10
Affiliated clinicians 1
Medicare Care Compare: Dialysis facility
- Listed as
- DaVita Baxley Dialysis
- Overall star rating
- ★★☆☆☆ 2.0 of 5
- Ownership
- Profit
- Certified
- May 7, 1997
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 13
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0929221 | Baxley Dialysis | Certificate of waiver | Jun 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030321000004 | GA | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 0840107611 |
1 other NPI on this enrollment Practice locations: Baxley, GA |
National Provider Directory
- Tax ID family
- Gambro Healthcare Anahe
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | ESRD001055 | GA | Yes |
Addresses
Primary practice location
539 Fair St
Baxley, GA 31513-0112
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000758403C | Medicaid | GA |
Other names
- Baxley Dialysis
Other providers in Baxley, GA
- Deeper Waters Emdr
- Dental Center of Baxley
- Ray Ashley Dixon
- Doctors of Compassionate Services
- Robert D Drawdy
- E Buford Kesler Dba
- East Georgia Healthcare Center Inc
- Melina Edmund
- Barbara Nicole Ellis
- Excelcare Ambulance Service, Inc
All providers in Baxley, GA · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2024. 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.