Organization Name: | DVA HEALTHCARE RENAL CARE, INC. |
NPI Number: | 1073581310 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THOMAS O USILTON (GROUP VICE PRESIDENT) |
Mailing Address: | 11306 N 53rd St Temple Terrace |
State: | FL US |
Postal Code: | 336172214 |
Phone Number: | 8139892062 |
Fax Number: | 8139893658 |
NPI Enumeration Date: | 03/11/2006 |
NPI Last Update Date: | 08/15/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |