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	3336M0002X	Mail Order Pharmacy	2939	MT
2	3336M0002X	Mail Order Pharmacy	3950	IA
3	3336M0002X	Mail Order Pharmacy	MO40001100	ME
4	3336M0002X	Mail Order Pharmacy	PCN0002204	CT
5	3336M0002X	Mail Order Pharmacy	22-02806	KS
6	3336M0002X	Mail Order Pharmacy	PHNR000333	GA
7	3336M0002X	Mail Order Pharmacy	P05392	MD
8	3336M0002X	Mail Order Pharmacy	10674	NC
9	3336M0002X	Mail Order Pharmacy	OSP-5916	CO
10	3336M0002X	Mail Order Pharmacy	TN1497	KY
11	3336M0002X	Mail Order Pharmacy	PH24924	FL
12	3336M0002X	Mail Order Pharmacy	OS-006427	LA
13	3336M0002X	Mail Order Pharmacy	64001119A	IN
14	3336M0002X	Mail Order Pharmacy	2010033148	MO
15	3336M0002X	Mail Order Pharmacy	113344	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2093259	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841235850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CLINIC INC

Provider Business Mailing Address
First Line	:	2911 FOSTER CREIGHTON DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3705
Country	:	US
Telephone Number	:	615-259-2426
Fax Number	:	615-259-2862

Provider Business Practice Location Address
First Line	:	2911 FOSTER CREIGHTON DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3705
Country	:	US
Telephone Number	:	615-259-2426
Fax Number	:	615-259-2862

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	10/05/2023

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Directions to “DIALYSIS CLINIC INC ” Practice Location

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