Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
St Matthews Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O USILTON JR. (GROUP VICE PRESIDENT)
(770) 541-7922
Entity
Organization
Contact information
Practice address
602 N F R HUFF DR, ST MATTHEWS, SC 29135-9596
(803) 655-7758
(803) 655-7764
Mailing address
5200 VIRGINIA WAY, STE. 400 L&C, BRENTWOOD, TN 37027-7569
(615) 320-4218
(303) 209-7825
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ERD066
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425623
—
SC
Enumeration date
04/05/2006
Last updated
07/11/2007
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