Healthcare Provider Details

I. General information

NPI: 1316966559
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

2077 CATON ST STE A
NEW ORLEANS LA
70122-3146
US

IV. Provider business mailing address

1661 CANAL ST STE 1001
NEW ORLEANS LA
70112-2824
US

V. Phone/Fax

Practice location:
  • Phone: 504-242-3770
  • Fax: 504-242-9937
Mailing address:
  • Phone: 504-581-4957
  • Fax: 504-391-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number068
License Number StateLA

VIII. Authorized Official

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