Provider Demographics
NPI:1497718977
Name:DCA OF KILMARNOCK, LLC
Entity Type:Organization
Organization Name:DCA OF KILMARNOCK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-694-0500
Mailing Address - Street 1:214 SENATE AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2339
Mailing Address - Country:US
Mailing Address - Phone:717-730-9701
Mailing Address - Fax:717-730-6223
Practice Address - Street 1:77 IRVINGTON RD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3826
Practice Address - Country:US
Practice Address - Phone:804-435-0888
Practice Address - Fax:804-435-0995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIALYSIS CORPORATION OF AMERICA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA210370OtherANTHEM BCBS
VA=========OtherTRICARE