LAKE CHARLES SOUTH DIALYSIS
NPI 1750340816
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Lake Charles, LA
- Organization
- Clinic/Center
- End-Stage Renal Disease (ESRD) Treatment
- CLIA Number: 19D0915936
- CLIA Cert. Type: End Stage Renal Disease Dialysis Facility
- CLIA Exp. Date: 06-10-2028
About LAKE CHARLES SOUTH DIALYSIS
This page provides the complete NPI Profile along with additional information for Lake Charles South Dialysis, a provider established in Lake Charles, Louisiana operating as a Clinic/center, focusing in end-stage renal disease (esrd) treatment . The healthcare provider is registered in the NPI registry with number 1750340816 assigned on March 2006. The practitioner's primary taxonomy code is 261QE0700X with license number 091 (LA). The provider is registered as an organization and their NPI record was last updated 19 years ago. The provider's is doing business as Lake Charles South Dialysis. The authorized official of this NPI record is Thomas O Usilton Jr. (Group Vice President)
- NPI
- 1750340816 Verify this NPI
- Provider Legal Name
- DVA RENAL HEALTHCARE INC
- Other Organization Name
- LAKE CHARLES SOUTH DIALYSIS
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 4015 COMMON ST LAKE CHARLES, LA 70607
- Location Phone
- (337) 562-2022
- Location Fax
- (337) 562-2555
- Mailing Address
- 5200 VIRGINIA WAY STE 400 L&C BRENTWOOD, TN 37027
- Mailing Phone
- (615) 320-4218
- Mailing Fax
- (303) 209-7825
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-18-2006
- Last Update Date
- 07-11-2007
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center End-Stage Renal Disease (ESRD) Treatment
- Taxonomy Code
- 261QE0700X
- Type
- Ambulatory Health Care Facilities
- License No.
- 091
- License State
- LA
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 192634 | MEDICARE OSCAR/CERTIFICATION (06) | ||
| 1102199 | MEDICAID (05) | LA |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 19D0915936
- Facility Type
- End Stage Renal Disease Dialysis Facility
- Certificate Effective Date
- June 11, 2026
- Certificate Expiration Date
- June 10, 2028
- Laboratory Director
- ASIF NISAR
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Lake Charles South Dialysis to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1750340816, enumerated as an "organization" on March 18, 2006.
The provider is located at 4015 COMMON ST LAKE CHARLES, LA 70607 and the phone number is (337) 562-2022.
Clinic/Center with taxonomy code 261QE0700X and a focus in End-Stage Renal Disease (ESRD) Treatment.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
