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DVA HEALTHCARE RENAL CARE INC NPI 1174590749


NPI Information

NPI: 1174590749
Provider Name: DVA HEALTHCARE RENAL CARE INC

Doing Business As: BARTOW DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 10D0715085

Address:
2295 E FLAMINGO DR
BARTOW, FL
ZIP 33830
Phone: (863) 533-1601
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DVA HEALTHCARE RENAL CARE INC is an end-stage renal disease (esrd) treatment clinic center in Bartow, FL. DVA HEALTHCARE RENAL CARE INC NPI is 1174590749. The provider is registered as an organization entity type.
The provider Is Doing Business As Bartow Dialysis.

The provider's business location address is:

2295 E FLAMINGO DR
BARTOW, FL
ZIP 33830-203
Phone: (863) 533-1601
Fax: (863) 519-4415

The provider's authorized official is John D Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 10D0715085 - end stage renal disease dialysis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/2/2006 and was last updated on 4/14/2021.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1209684600MEDICAIDFLORIDA

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: 11/14/2023

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.