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

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

General Provider Information

NPI Number	:	1972705648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CLINIC INC.

Provider Business Mailing Address
First Line	:	2022 E PRINCE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2005
Country	:	US
Telephone Number	:	520-327-0007
Fax Number	:	520-327-6902

Provider Business Practice Location Address
First Line	:	1700 W COMMERCE POINT PL
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-5095
Country	:	US
Telephone Number	:	520-327-0007
Fax Number	:	520-327-6902

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	10/05/2023

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