{"npi":"1013970110","type":"NPI-2","status":"active","name":{"display":"Dva Renal Healthcare INC","other":[],"organization_name":"DVA RENAL HEALTHCARE INC","authorised_official":"Samuel Wey"},"specialty":{"primary_taxonomy":"261QE0700X","primary_taxonomy_description":"End-Stage Renal Disease (ESRD) Treatment Clinic/Center","slug":"end-stage-renal-disease-esrd-treatment-clinic-center","schema_org_specialty":null,"all":[{"code":"261QE0700X","description":"End-Stage Renal Disease (ESRD) Treatment Clinic/Center","primary":true,"state":"KY","license":"300121"}]},"addresses":[{"purpose":"LOCATION","street_1":"525 ALEXANDRIA PIKE","city":"SOUTHGATE","state":"KY","postal_code":"410713243","country_code":"US","street_2":"STE 120","phone":"8594425539","fax":"8594425587"},{"purpose":"MAILING","street_1":"5200 VIRGINIA WAY","city":"BRENTWOOD","state":"TN","postal_code":"370277569","country_code":"US","street_2":"ATT: L&C DEPT","phone":"6152383051","fax":"8002468346"}],"license":{"state":"KY","number":"300121"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"2121457","state":"OH","issuer":null},{"type_code":"05","label":"Medicaid","value":"3900020300","state":"KY","issuer":null}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2006-04-10","last_updated":"2023-10-27","_meta":{"source":"NPPES","snapshot_date":"2023-10-27","doc_url":"https://findmynpi.com/api"}}