Active NPI
Dva Renal Healthcare Inc
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Chula Vista, CA
National Provider Identifier
1568436715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- DVA RENAL HEALTHCARE INC
- Practice address
- 630 Bay Blvd
Ste 101
Chula Vista, CA 91910-5262 - Phone
- (619) 420-6725
- Fax
- (619) 420-6736
- NPI assigned
- Feb 15, 2006
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | CA | Primary |
Addresses
Primary practice location
630 Bay Blvd
Ste 101
Chula Vista, CA 91910-5262
Mailing address
5200 Virginia Way
Ste 400
Brentwood, TN 37027-7569
Phone (615) 320-4435
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CDC02731G | Medicaid | CA |
Other names 1
- Chula Vista Dialysis
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Pageland, SC
- NPI 1548222615
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1186963200000",
"number": "1568436715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5200 VIRGINIA WAY",
"address_2": "STE 400",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370277569",
"telephone_number": "615-320-4435",
"fax_number": "303-209-7821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 BAY BLVD",
"address_2": "STE 101",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919105262",
"telephone_number": "619-420-6725",
"fax_number": "619-420-6736"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DVA RENAL HEALTHCARE INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-15",
"last_updated": "2007-08-13",
"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": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CDC02731G",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Chula Vista Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.