Organization · Type 2 NPI

Dva Healthcare Renal Care Inc

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Fairfax, SC

NPI number 1073575171 Active

Practice location

1241 Boundary St W
Fairfax, SC 29827-3611

Call (803) 632-1587 Map

Fax (803) 632-1611

Mailing address

5200 Virginia Way, L&c Dept
Brentwood, TN 37027-7569

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	ERD-0059 (SC)

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

NPI record

NPI: 1073575171
Entity type: Organization (Type 2)
Issued: Apr 4, 2006
Last updated: May 18, 2026
Status: Active

Other names

<unavail>
Allendale County Dialysis · doing business as
Allendale County Dialysis · doing business as

Authorized official

Samuel T Wey
VP, Licensure & Certification
(615) 341-6641

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1073575171

Dva Healthcare Renal Care Inc's National Provider Identifier is 1073575171, issued on Apr 4, 2006. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Fairfax, SC. The record was last updated on May 18, 2026.