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	ERD-006	SC

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	:	1578596953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CLINIC INC.

Provider Business Mailing Address
First Line	:	2270 TECHNICAL PKWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29406-4930
Country	:	US
Telephone Number	:	843-863-8974
Fax Number	:	843-863-9590

Provider Business Practice Location Address
First Line	:	2270 TECHNICAL PKWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29406-4930
Country	:	US
Telephone Number	:	843-723-7227
Fax Number	:	843-863-9590

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

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

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