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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/Center110000460CA

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 : 1902839384
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIALYSIS CLINIC INC.
Provider Business Mailing Address
First Line : 7231 E SOUTHGATE DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95823-2620
Country : US
Telephone Number : 916-395-7585
Fax Number : 916-395-6602
Provider Business Practice Location Address
First Line : 7231 E SOUTHGATE DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95823-2620
Country : US
Telephone Number : 916-395-7585
Fax Number : 916-395-6602
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 : 10/05/2023

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