Healthcare Provider Details

I. General information

NPI: 1942391131
Provider Name (Legal Business Name): DIALYSIS CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DAWN LANE
WAVERLY OH
45680
US

IV. Provider business mailing address

1207 17TH STREET
PORTSMOUTH OH
45662
US

V. Phone/Fax

Practice location:
  • Phone: 740-841-1062
  • Fax: 740-497-7905
Mailing address:
  • Phone: 740-351-0596
  • Fax: 740-351-0647

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