DVA RENAL HEALTHCARE INC NPI 1245290782

NPI Information

NPI: 1245290782
Provider Name: DVA RENAL HEALTHCARE INC

Doing Business As: EFFINGHAM DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
904 MEDICAL PARK DR
SUITE 1
EFFINGHAM, IL
ZIP 62401
Phone: (217) 342-9558
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DVA RENAL HEALTHCARE INC is an end-stage renal disease (esrd) treatment clinic center in Effingham, IL. DVA RENAL HEALTHCARE INC NPI is 1245290782. The provider is registered as an organization entity type.
The provider Is Doing Business As Effingham Dialysis.

The provider's business location address is:

904 MEDICAL PARK DR
SUITE 1
EFFINGHAM, IL
ZIP 62401-193
Phone: (217) 342-9558
Fax: (217) 342-1049

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 14D0723759 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/27/2006 and was last updated on 12/13/2021.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	N/A	ILLINOIS	Yes

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
1	2300487	MEDICAID	OHIO

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: 5/5/2024

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