NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

Doing business as Southern Maryland Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Clinton, MD
National Provider Identifier
1386604932
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
E2563 Issued in MD
Legal business name
DVA HEALTHCARE RENAL CARE INC
Doing business as
Southern Maryland Dialysis
Practice address
9211 Stuart LN FL 4
Clinton, MD 20735-2712
Phone
(301) 856-6602
Fax
(301) 856-6623
NPI assigned
Mar 27, 2006
Last updated
Feb 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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

Authorized official

Name
John Winstel
Title
Chief Accounting Officer
Phone
(253) 733-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X E2563 MD Primary

Addresses

Primary practice location

9211 Stuart LN FL 4
Clinton, MD 20735-2712

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4214

Other identifiers 3

IdentifierTypeStateIssuer
033655800MedicaidDC
724400200MedicaidMD
002125633MedicaidVA

Other names 1

  • Southern Maryland Dialysis Doing business as

National Provider Directory

National Provider Directory

Member of 2

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

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1386604932",
    "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": "615-320-4214",
            "fax_number": "866-944-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9211 STUART LN FL 4",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207352712",
            "telephone_number": "301-856-6602",
            "fax_number": "301-856-6623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "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": "MD",
            "license": "E2563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033655800",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "724400200",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002125633",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Maryland Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Maryland Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.