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General NPI Number Information
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NPI Number | 1497783047
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Entity Type | Organization
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Legal Business Name | DIALYSIS CLINIC INC.
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 6104 N MACK SMITH RD
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City | EAST RIDGE
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State | TN
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Zip | 37412-3960
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Country | US
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Telephone | 423-894-8133
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Fax | 423-894-8337
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Provider Business Mailing Address
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Address Line | 6104 N MACK SMITH RD
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City | EAST RIDGE
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State | TN
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Zip | 37412-3960
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Country | US
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Telephone | 423-894-8133
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Fax | 426-894-8337
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DONOVAN SCHULTZ
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Credential |
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Telephone | 615-327-3061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 0000000050
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License Number State | TN
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