Healthcare Provider Details

I. General information

NPI: 1275747735
Provider Name (Legal Business Name): DIALYSIS CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 LOUISIANA BLVD, NE
ALBUQUERQUE NM
87110-7048
US

IV. Provider business mailing address

1500 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87102-1646
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-1800
  • Fax: 505-254-1801
Mailing address:
  • Phone: 505-243-7376
  • Fax: 505-724-1526

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