MEDICARE: DCI RENAL SERVICES OF PITTSBURGH LLC

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

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

General Provider Information

NPI Number	:	1851310098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DCI RENAL SERVICES OF PITTSBURGH LLC

Provider Business Mailing Address
First Line	:	3260 5TH AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3026
Country	:	US
Telephone Number	:	412-647-3700
Fax Number	:	412-647-6980

Provider Business Practice Location Address
First Line	:	6314 FORBES AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1717
Country	:	US
Telephone Number	:	412-521-4370
Fax Number	:	412-521-4371

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/11/2023

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