Dva Renal Healthcare, Inc.
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · MC Minnville, TN
NPI 1649233222 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1649233222
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 113 (TN)
- Legal business name
- DVA RENAL HEALTHCARE, INC.
- Practice address
- 835 Smithville Hwy
#15
MC Minnville, TN 37110-1669 - Phone
- (931) 473-9553
- Fax
- (931) 473-2676
- NPI assigned
- Apr 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Thomas O. Usilton Jr.
- Title
- Group Vice President
- Phone
- (770) 541-7922
Corporate family (same tax ID) 9
National Provider Directory
- Tax ID family
- Gambro Healthcare Anahe
Locations
835 Smithville Hwy
Ste 15
McMinnville, TN 37110
Phone (931) 473-9553
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 113 | TN | Yes |
Addresses
Primary practice location
835 Smithville Hwy
#15
MC Minnville, TN 37110-1669
Mailing address
5200 Virginia Way
Ste. 400 L&C
Brentwood, TN 37027-7569
Phone (615) 320-4218
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0442558 | Medicaid | TN |
Other names
- McMinnville Dialysis
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All providers in MC Minnville, TN · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.