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
1	291U00000X	Clinical Medical Laboratory	TN 1953	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4909-843025A3	OTHER	NY	NEW YORK LAB LICENSE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	021177	OTHER	PA	PA LAB LICENSE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	COS 800031	OTHER	CA	CA LAB LICENSE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	44D0659053	OTHER	TN	CLIA
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	800011550	OTHER	FL	FL LAB LICENSE
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
19	TN 1953	OTHER	TN	STATE LICENSE

General Provider Information

NPI Number	:	1417952268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CLINIC INC

Provider Business Mailing Address
First Line	:	2917 FOSTER CREIGHTON DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3705
Country	:	US
Telephone Number	:	615-255-5227
Fax Number	:	615-259-9321

Provider Business Practice Location Address
First Line	:	2917 FOSTER CREIGHTON DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3705
Country	:	US
Telephone Number	:	615-255-5227
Fax Number	:	615-259-9321

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONOVAN SCHULTZ
Credential	:
Telephone Number	:	615-327-3061

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/04/2023

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Directions to “DIALYSIS CLINIC INC ” Practice Location

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