Organization
DIALYSIS CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONOVAN SCHULTZ (PRESIDENT)
(615) 327-3061
Entity
Organization
Contact information
Practice address
80A VETERANS BLVD, ACOMA, NM 87034
(505) 552-7292
(505) 552-7275
Mailing address
PO BOX 189, SAN FIDEL, NM 87049-0189
(505) 552-7292
(505) 552-7275
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
3054
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45997
—
CA
05
—
G8529
—
NM
Enumeration date
07/08/2006
Last updated
10/04/2023
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