Healthcare Provider Details

I. General information

NPI: 1851756183
Provider Name (Legal Business Name): DIALYSIS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 FISK STREET
PITTSBURGH PA
15201-1752
US

IV. Provider business mailing address

3412 BABCOCK BLVD
PITTSBURGH PA
15237-2402
US

V. Phone/Fax

Practice location:
  • Phone: 412-635-0211
  • Fax:
Mailing address:
  • Phone: 412-635-0211
  • Fax: 412-635-0411

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