Dva Healthcare Renal Care Inc

Primary specialty

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

Legal business name

DVA HEALTHCARE RENAL CARE INC

Doing business as

Lucedale Dialysis

Practice address

652 Manila St
Lucedale, MS 39452-5962

Phone

(601) 947-8701

Fax

(601) 947-8980

NPI assigned

Mar 28, 2006

Organization subpart

No

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

Authorized official

Name

Samuel Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lucedale Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Tax ID family

CDS of Zephyrhills194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 2

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 Ocean Springs Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Ocean Springs, MS
  • NPI 1043271414
  NPD tax ID
• Dva Healthcare Renal Care Inc

  dba Singing River Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pascagoula, MS
  • NPI 1538120902
  NPD tax ID

Member of 1

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

• Dva Renal Healthcare Inc

  dba Pageland Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pageland, SC
  • NPI 1548222615

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1629039086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 MANILA ST",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394525962",
            "telephone_number": "601-947-8701",
            "fax_number": "601-947-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00220525",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lucedale Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lucedale Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Delco Inc (Glen Oaks Nursing Center)
• Dalton Detty, DC
• Timothy Downs Sr.
• Dr. Ronnie Harrison P.a.
• Ginger E. Dunnam-Smith, M.D.
• E Kevin Ohea MD General Family Practice LLC
• Autumn Denise Edwards
• Lendon L Elmore
• Encore Rehabilitation Inc (Encore Rehab of Lucedale)
• Ashley Nicole Eubanks, PHARMD

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Lucedale, MS
• Providers in Lucedale, MS by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; 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.