Dva Healthcare Renal Care Inc

Primary specialty

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

License

170048 Issued in OR

Legal business name

DVA HEALTHCARE RENAL CARE INC

Doing business as

Woodburn Dialysis

Practice address

1840 Newberg Hwy
Ste 140
Woodburn, OR 97071-3187

Phone

(503) 982-2005

Fax

(503) 982-2561

NPI assigned

Apr 4, 2006

Last updated

Aug 29, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Woodburn Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Tax ID family

Community Dialysis Services194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 3

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Dva Healthcare Renal Care Inc

  dba Woodburn Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Woodburn, OR
  • NPI 1487984357
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Roseburg Mercy Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Roseburg, OR
  • NPI 1568424711
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Salem Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Salem, OR
  • NPI 1992767149
  NPD tax ID

Member of 1

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

• Dva Renal Healthcare Inc

  dba Florissant Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saint Louis, MO
  • NPI 1740241454

  Member Of

  NPD member

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1467414623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 NEWBERG HWY",
            "address_2": "STE 140",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970713187",
            "telephone_number": "503-982-2005",
            "fax_number": "503-982-2561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "OR",
            "license": "170048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133038",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodburn Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Woodburn Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cassandra Dotson
• Hannah Drill
• Jennifer Duarte
• Victor Manuel Duarte
• Charlene Dee Dutton, RN
• Dva Healthcare Renal Care Inc (Woodburn Dialysis)
• Pearl Dzata
• Heather Marie Eason, MS, CCC-SLP
• Sandra Echavarria
• Patricia Eddy, PT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Woodburn, OR
• Providers in Woodburn, OR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.