DVA HEALTHCARE RENAL CARE INC NPI 1104895143

NPI Information

NPI: 1104895143
Provider Name: DVA HEALTHCARE RENAL CARE INC

Doing Business As: BRUNSWICK DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
53 SCRANTON CONNECTOR
BRUNSWICK, GA
ZIP 31525
Phone: (912) 264-8657
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DVA HEALTHCARE RENAL CARE INC is an end-stage renal disease (esrd) treatment clinic center in Brunswick, GA. DVA HEALTHCARE RENAL CARE INC NPI is 1104895143. The provider is registered as an organization entity type.
The provider Is Doing Business As Brunswick Dialysis.

The provider's business location address is:

53 SCRANTON CONNECTOR
BRUNSWICK, GA
ZIP 31525-862
Phone: (912) 264-8657
Fax: (912) 265-6542

The provider's authorized official is Samuel T. Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 11D0646119 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/14/2006 and was last updated on 12/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	ESRD001131	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	890065500	MEDICAID	FLORIDA
2	000410165A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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