Dva Healthcare Renal Care Inc

Primary specialty

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

License

ERD066 Issued in SC

Legal business name

DVA HEALTHCARE RENAL CARE INC

Practice address

602 N F R Huff Dr
St Matthews, SC 29135-9596

Phone

(803) 655-7758

Fax

(803) 655-7764

NPI assigned

Apr 5, 2006

Organization subpart

No

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

Authorized official

Name

Thomas O Usilton Jr.

Title

Group Vice President

Phone

(770) 541-7922

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St Matthews Dialysis Doing business as

Member of 2

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
• Dva Healthcare Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pearsall, TX
  • NPI 1194789859

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184112000000",
    "number": "1447212451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "STE. 400 L&C",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4218",
            "fax_number": "303-209-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N F R HUFF DR",
            "city": "ST MATTHEWS",
            "state": "SC",
            "postal_code": "291359596",
            "telephone_number": "803-655-7758",
            "fax_number": "803-655-7764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2007-07-11",
        "status": "A",
        "authorized_official_last_name": "USILTON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "GROUP VICE PRESIDENT",
        "authorized_official_telephone_number": "770-541-7922",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "SC",
            "license": "ERD066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425623",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Matthews Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wanda O Copeland, FNP
• Tina Ashley Davenport
• Darcy C Davis
• Courtney Cooper Dixon, MSP, CCC-SLP
• Mary Elizabeth Doucette, LMT
• Earl B Hartzog DMD PA
• Edisto Regional Health Services
• Edisto Regional Health Services Inc.
• Paige Julia Edwards, DO
• Christina Walker Elmore, RD,

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in St Matthews, SC
• Providers in St Matthews, 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 Jul 11, 2007; 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.