Healthcare Provider Details

I. General information

NPI: 1134773617
Provider Name (Legal Business Name): DIALYSIS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W AVON RD
AVON CT
06001-3680
US

IV. Provider business mailing address

1633 CHURCH ST STE 500
NASHVILLE TN
37203-2948
US

V. Phone/Fax

Practice location:
  • Phone: 860-269-3370
  • Fax: 860-269-3371
Mailing address:
  • Phone: 615-327-3061
  • Fax: 615-329-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DONOVAN SCHULTZ
Title or Position: PRESIDENT
Credential:
Phone: 615-327-3061