Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Effingham North Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
1451 GA HIGHWAY 21 S STE A, SPRINGFIELD, GA 31329-5244
(912) 754-4289
(912) 754-6564
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001022
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000893153G
—
GA
05
—
ES3001
—
SC
Enumeration date
03/14/2006
Last updated
01/29/2021
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