DVA RENAL HEALTHCARE INC NPI 1316916513

NPI Information

NPI: 1316916513
Provider Name: DVA RENAL HEALTHCARE INC

Doing Business As: JACKSONVILLE DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
1515 W WALNUT ST
JACKSONVILLE, IL
ZIP 62650
Phone: (217) 243-3042
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DVA RENAL HEALTHCARE INC is an end-stage renal disease (esrd) treatment clinic center in Jacksonville, IL. DVA RENAL HEALTHCARE INC NPI is 1316916513. The provider is registered as an organization entity type.
The provider Is Doing Business As Jacksonville Dialysis.

The provider's business location address is:

1515 W WALNUT ST
JACKSONVILLE, IL
ZIP 62650-150
Phone: (217) 243-3042
Fax: (217) 243-1365

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 14D0723758 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/17/2006 and was last updated on 10/18/2023.

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			Yes

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

NPI Synchronization or Removal

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