DAVITA TIDEWATER - VIRGINIA BEACH LLC NPI 1710066428

NPI Information

  • NPI: 1710066428
  • Provider Name: DAVITA TIDEWATER - VIRGINIA BEACH, LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: CAMELOT DIALYSIS
  • CLIA Number: 49D0228897
  • Address: 1800 CAMELOT DR
    STE 100
    VIRGINIA BEACH, VA
    ZIP 23454
  • Phone: (757) 481-6879

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NPI Details

DAVITA TIDEWATER - VIRGINIA BEACH, LLC is an end-stage renal disease (esrd) treatment clinic center in Virginia Beach, VA. DAVITA TIDEWATER - VIRGINIA BEACH, LLC NPI is 1710066428. The provider is registered as an organization entity type.
The provider Is Doing Business As Camelot Dialysis.

The provider's business location address is:

1800 CAMELOT DR
STE 100
VIRGINIA BEACH, VA
ZIP 23454-440
Phone: (757) 481-6879
Fax: (757) 496-0187

The provider's authorized official is Thomas O Usilton .
The authorized official title is Sr Vice President and has the following contact phone number (770) 541-7922.

The CLIA number assigned to this NPI record is 49D0228897 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/3/2006 and was last updated on 8/22/2020.

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
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

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: 3/30/2025

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