MEDICARE: DIALYSIS CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275566655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CLINIC, INC.

Provider Business Mailing Address
First Line	:	6530 TROOST AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1230
Country	:	US
Telephone Number	:	816-363-8228
Fax Number	:	816-363-1445

Provider Business Practice Location Address
First Line	:	6530 TROOST AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1230
Country	:	US
Telephone Number	:	816-363-8228
Fax Number	:	816-363-1445

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONOVAN SCHULTZ
Credential	:
Telephone Number	:	615-327-3061

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	10/04/2023

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