NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

Doing business as Central Columbia Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Columbia, SC
National Provider Identifier
1508828617
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ERD116 Issued in SC
Legal business name
DVA HEALTHCARE RENAL CARE INC
Doing business as
Central Columbia Dialysis
Practice address
3511 Medical Dr
Columbia, SC 29203-6504
Phone
(803) 771-0518
Fax
(803) 771-7286
NPI assigned
Apr 4, 2006
Last updated
Jul 10, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X ERD116 SC Primary

Addresses

Primary practice location

3511 Medical Dr
Columbia, SC 29203-6504

Mailing address

5200 Virginia Way
Ste. 400 L&C
Brentwood, TN 37027-7569
Phone (615) 320-4218

Other identifiers 1

IdentifierTypeStateIssuer
425294MedicaidSC

Other names 1

  • Central Columbia 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": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1508828617",
    "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": "3511 MEDICAL DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036504",
            "telephone_number": "803-771-0518",
            "fax_number": "803-771-7286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2007-07-10",
        "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": "ERD116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425294",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Columbia Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.