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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		AL

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	S5107	OTHER	AL	STATE LICENSE

General Provider Information

NPI Number	:	1710200274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CLINIC INC.

Provider Business Mailing Address
First Line	:	544 S MCDONOUGH ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-4614
Country	:	US
Telephone Number	:	334-265-9190
Fax Number	:	334-241-4339

Provider Business Practice Location Address
First Line	:	1912 CHERRY ST.
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36107-2607
Country	:	US
Telephone Number	:	334-264-1060
Fax Number	:	334-265-0036

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

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	10/05/2023

Similar Medicare Providers

1376521112 — DR. EMMETT WARD SMITH D.M.D.
Practice Location Address:

3150 ZELDA CT
MONTGOMERY, AL
36106-2607

Practice Phone: 334-281-2451
Practice Fax: 334-281-1087

1245205657 — MRS. OLIVIA ANN FERRARI CNP
Practice Location Address:

4605 MONTGOMERY RD , INSIDE WALGREENS
CINCINNATI, OH
45212-2607

Practice Phone: 513-826-5351
Practice Fax: 513-826-5352

1598770596 — WALGREEN CO
Practice Location Address:

4605 MONTGOMERY RD
NORWOOD, OH
45212-2607

Practice Phone: 513-731-0062
Practice Fax:

1689783516 — DR. STEPHEN PATRICK MCCULLOCH D.M.D.
Practice Location Address:

3150 ZELDA CT
MONTGOMERY, AL
36106-2607

Practice Phone: 334-281-2451
Practice Fax:

1053421982 — DR. FORREST ELDRED WATERS III D.M.D.
Practice Location Address:

3150 ZELDA CT
MONTGOMERY, AL
36106-2607

Practice Phone: 334-281-2451
Practice Fax:

1831208750 — DR. DAVID MICHAEL LIEUX D.D.S.
Practice Location Address:

3150 ZELDA CT
MONTGOMERY, AL
36106-2607

Practice Phone: 334-281-2451
Practice Fax:

Directions to “DIALYSIS CLINIC INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.