Healthcare Provider Details

I. General information

NPI: 1811185028
Provider Name (Legal Business Name): DIALYSIS CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 HARRODSBURG RD SUITE D-304
LEXINGTON KY
40504-3758
US

IV. Provider business mailing address

1451 HARRODSBURG RD SUITE D-304
LEXINGTON KY
40504-3758
US

V. Phone/Fax

Practice location:
  • Phone: 859-977-4000
  • Fax: 859-977-5100
Mailing address:
  • Phone: 859-977-4000
  • Fax: 859-977-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number36247
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number37363
License Number StateKY

VIII. Authorized Official

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