Monroe Jackson St Dialysis

LBN: Dva Renal Healthcare Inc
Monroe Jackson St Dialysis is an health care organization with primary practice located at 309 Jackson St , Monroe LA 71201-7407. The organization recently has only one registered license in Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment, which is considered as the primary health care specialty. Dva Renal Healthcare Inc can be contacted via phone (318) 327-4409, or through Usilton, Thomas O via phone (770) 541-7922.

Contact Information

Primary practice address
309 Jackson St Monroe LA 71201-7407
Phone: (318) 327-4409
Fax: (318) 323-9339
Website:
Map and Directions
Authorized official contact:
Name: Usilton, Thomas O
Phone: (770) 541-7922

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / End-Stage Renal Disease (ESRD) Treatment 261QE0700X 070 Louisiana

Profile Details

NPI number 1962461038
LBN Legal business name Dva Renal Healthcare Inc
DBA Doing business as Monroe Jackson St Dialysis
Authorized official Usilton, Thomas O
Entity Organization
Organization subpart 1 No
Enumeration date Mar 18th, 2006
Last updated Aug 14th, 2007 - about 19 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962461038 NPPES
Louisiana MEDICAID 1149594

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