Healthcare Provider Details

I. General information

NPI: 1407875644
Provider Name (Legal Business Name): DIALYSIS CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 E MAIN ST SUITE 206
DANVILLE IN
46122-1971
US

IV. Provider business mailing address

1719 W 10TH ST
INDIANAPOLIS IN
46222-3801
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-8781
  • Fax: 317-745-8785
Mailing address:
  • Phone: 317-631-2005
  • Fax: 317-631-0597

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