DVA HEALTHCARE RENAL CARE INC NPI 1972572949

NPI Information

NPI: 1972572949
Provider Name: DVA HEALTHCARE RENAL CARE INC

Doing Business As: WYLDS ROAD DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
1815 WYLDS RD
AUGUSTA, GA
ZIP 30909
Phone: (706) 733-0522
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DVA HEALTHCARE RENAL CARE INC is an end-stage renal disease (esrd) treatment clinic center in Augusta, GA. DVA HEALTHCARE RENAL CARE INC NPI is 1972572949. The provider is registered as an organization entity type.
The provider Is Doing Business As Wylds Road Dialysis.

The provider's business location address is:

1815 WYLDS RD
AUGUSTA, GA
ZIP 30909-430
Phone: (706) 733-0522
Fax: (706) 733-0432

The provider's authorized official is John 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 11D0711782 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/14/2006 and was last updated on 10/26/2021.

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	ESRD001090	GEORGIA	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	000534388A	MEDICAID	GEORGIA
2	125797	MEDICAID	SOUTH CAROLINA

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: 4/28/2024

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