DAVITA TIDEWATER - VIRGINIA BEACH LLC NPI 1710066428

NPI Information

DAVITA TIDEWATER - VIRGINIA BEACH, LLC is an end-stage renal disease (esrd) treatment clinic center in Virginia Beach, VA. DAVITA TIDEWATER - VIRGINIA BEACH, LLC NPI is 1710066428. The provider is registered as an organization entity type.
The provider Is Doing Business As Camelot Dialysis.

The provider's business location address is:

1800 CAMELOT DR
STE 100
VIRGINIA BEACH, VA
ZIP 23454-440
Phone: (757) 481-6879
Fax: (757) 496-0187

The provider's authorized official is Thomas O Usilton .
The authorized official title is Sr Vice President and has the following contact phone number (770) 541-7922.

The CLIA number assigned to this NPI record is 49D0228897 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/3/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.