Organization
DAVITA TIDEWATER - VIRGINIA BEACH, LLC
Active
Other names
Camelot Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O USILTON JR. (SR VICE PRESIDENT)
(770) 541-7922
Entity
Organization
Contact information
Practice address
1800 CAMELOT DR, STE 100, VIRGINIA BEACH, VA 23454-2440
(757) 481-6879
(757) 496-0187
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
—
—
Other
Enumeration date
11/03/2006
Last updated
08/22/2020
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