Healthcare Provider Details

I. General information

NPI: 1033138276
Provider Name (Legal Business Name): DCI RENAL SERVICES OF PITTSBURGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 MONROEVILLE BLVD
MONROEVILLE PA
15146-2329
US

IV. Provider business mailing address

2534 MONROEVILLE BLVD
MONROEVILLE PA
15146-2329
US

V. Phone/Fax

Practice location:
  • Phone: 412-823-6041
  • Fax: 412-823-6493
Mailing address:
  • Phone: 412-823-6041
  • Fax: 412-823-6493

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1022869480003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1206547
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

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