Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Lake Charles South 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
4015 COMMON ST, LAKE CHARLES, LA 70607-2942
(337) 562-2022
(337) 562-2555
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
091
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1102199
—
LA
Enumeration date
03/18/2006
Last updated
07/11/2007
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