DVA RENAL HEALTHCARE INC NPI 1154380228

NPI Information

  • NPI: 1154380228
  • Provider Name: DVA RENAL HEALTHCARE INC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: LAKE CHARLES SOUTHWEST DIALYSIS
  • CLIA Number: 19D0915936
  • Address: 300 18TH ST
    LAKE CHARLES, LA
    ZIP 70601
  • Phone: (337) 433-6831

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NPI Details

DVA RENAL HEALTHCARE INC is an end-stage renal disease (esrd) treatment clinic center in Lake Charles, LA. DVA RENAL HEALTHCARE INC NPI is 1154380228. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Charles Southwest Dialysis.

The provider's business location address is:

300 18TH ST
LAKE CHARLES, LA
ZIP 70601-342
Phone: (337) 433-6831
Fax: (337) 433-6613

The provider's authorized official is Samuel T Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 19D0915936 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/18/2006 and was last updated on 2/20/2024.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment060LOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11102121MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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