NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Demopolis, AL
National Provider Identifier
1477526754
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
S4601 Issued in AL
Legal business name
DVA HEALTHCARE RENAL CARE INC
Practice address
305 S Cedar Ave
Demopolis, AL 36732-2231
Phone
(334) 289-1394
Fax
(334) 289-1015
NPI assigned
Feb 8, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Samuel T Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Member of 1

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

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Demopolis DialysisCCN 012543
Overall star rating
1.0 of 5
Ownership
Profit
Certified
May 20, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
15

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0715167Demopolis Dialysis305 S Cedar Avenue, Demopolis, AL 36732Certificate of waiverAug 31, 2026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030411000002 AL Part a Provider - End-Stage Renal Disease Facility (ESRD) 7517875545 Practice locations: Demopolis, AL

National Provider Directory

National Provider Directory
Tax ID family
CDS of Zephyrhills194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 10

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

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X S4601 AL Primary

Addresses

NPPES NPI Registry

Primary practice location

305 S Cedar Ave
Demopolis, AL 36732-2231

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
1477526754MedicaidAL

Other names 1

NPPES NPI Registry
  • Demopolis Dialysis Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 23, 2025.

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747958400000",
    "number": "1477526754",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S CEDAR AVE",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367322231",
            "telephone_number": "334-289-1394",
            "fax_number": "334-289-1015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "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": "AL",
            "license": "S4601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477526754",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Demopolis Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Demopolis Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Demopolis, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.