Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Nodaway County 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
2613 S MAIN ST, MARYVILLE, MO 64468-3601
(660) 582-8329
(660) 582-8359
Mailing address
5200 VIRGINIA WAY, STE 400, BRENTWOOD, TN 37027-7569
(615) 320-4435
(303) 209-7821
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0576322
—
IA
Enumeration date
03/31/2006
Last updated
07/11/2007
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