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General NPI Number Information
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NPI Number | 1528164670
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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 | 09/16/2006
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 745 OLIVE ST SUITE 202
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City | SHREVEPORT
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State | LA
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Zip | 71104-2246
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Country | US
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Telephone | 318-673-8250
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Fax | 318-673-8252
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Provider Business Mailing Address
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Address Line | 1322 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4225
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Country | US
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Telephone | 318-673-8250
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Fax | 318-673-8252
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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 | 615-321-3061
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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 |
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License Number State |
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