Healthcare Provider Details

I. General information

NPI: 1023456787
Provider Name (Legal Business Name): DIALYSIS CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W ADAMS ST
BOWLING GREEN MO
63334-1974
US

IV. Provider business mailing address

3300 LEMONE INDUSTRIAL BLVD
COLUMBIA MO
65201-8246
US

V. Phone/Fax

Practice location:
  • Phone: 573-324-5300
  • Fax:
Mailing address:
  • Phone: 573-443-1531
  • Fax:

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