Healthcare Provider Details

I. General information

NPI: 1972630499
Provider Name (Legal Business Name): DIALYSIS CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 NW 83RD ST SUITE 101
GAINESVILLE FL
32606-5601
US

IV. Provider business mailing address

1633 CHURCH ST SUITE 500
NASHVILLE TN
37203-2990
US

V. Phone/Fax

Practice location:
  • Phone: 352-337-6021
  • Fax: 352-337-6025
Mailing address:
  • Phone: 615-327-3061
  • Fax: 615-321-3697

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