{"npi":"1720042096","type":"NPI-2","status":"active","name":{"display":"Dva Healthcare Southwest Ohio LLC","other":[],"organization_name":"DVA HEALTHCARE SOUTHWEST OHIO LLC","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":"OH","license":"0491DC"}]},"addresses":[{"purpose":"LOCATION","street_1":"1210 HICKS BLVD","city":"FAIRFIELD","state":"OH","postal_code":"450141921","country_code":"US","phone":"5139391110","fax":"5139391202"},{"purpose":"MAILING","street_1":"5200 VIRGINIA WAY","city":"BRENTWOOD","state":"TN","postal_code":"370277569","country_code":"US","street_2":"L&C DEPT","phone":"6152383051","fax":"8002468346"}],"license":{"state":"OH","number":"0491DC"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"3900031000","state":"KY","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20070529000064","type_code":"00-03","type_desc":"PART A PROVIDER - END-STAGE RENAL DISEASE FACILITY (ESRD)","state":"OH","pac_id":"8820908668"}]},"enumeration_date":"2006-04-13","last_updated":"2023-11-07","_meta":{"source":"NPPES","snapshot_date":"2023-11-07","doc_url":"https://findmynpi.com/api"}}