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NPI Code Detail

MEDICARE: DIALYSIS CLINIC INC.

MEDICARE: DIALYSIS CLINIC INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center0940CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053344531
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIALYSIS CLINIC INC.
Provider Business Mailing Address
First Line : 2748 CROSSROADS BLVD
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-3933
Country : US
Telephone Number : 970-255-0900
Fax Number : 970-255-0901
Provider Business Practice Location Address
First Line : 2748 CROSSROADS BLVD
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-3933
Country : US
Telephone Number : 970-255-0900
Fax Number : 970-255-0901
Authorized Official
Title or Position : PRESIDENT
Name : MR. DONOVAN SCHULTZ
Credential :
Telephone Number : 615-327-3061
Provider Enumeration Date : 07/08/2006
Last Update Date : 10/04/2023

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