Organization
DVA RENAL HEALTHCARE, INC.
Active
Other names
McMinnville 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
835 SMITHVILLE HWY, #15, MC MINNVILLE, TN 37110-1669
(931) 473-9553
(931) 473-2676
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
113
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0442558
—
TN
Enumeration date
04/06/2006
Last updated
08/22/2020
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