Organization
DVA HEALTHCARE OF MASSACHUSETTS INC
Active
Other names
Wellesley 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
195 WORCESTER ST, LOWER LEVEL, WELLESLEY, MA 02481-5568
(781) 431-1414
(781) 431-1144
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
E5UZ
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1311387
—
MA
Enumeration date
03/20/2006
Last updated
08/14/2007
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