Organization
DIALYSIS CLINIC INC.
Active
Organization
DIALYSIS CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONOVAN SCHULTZ (PRESIDENT)
(615) 329-2513
Entity
Organization
Contact information
Practice address
300 WESTFIELD PL, JASPER, TN 37347-5142
(423) 942-9977
(423) 942-9988
Mailing address
300 WESTFIELD PL, JASPER, TN 37347-5142
(423) 942-9977
(423) 942-9988
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0000000078
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00551867A
—
GA
05
—
044-2626
—
TN
05
—
DIA2626D
—
AL
05
—
TN0114
—
IL
Enumeration date
07/08/2006
Last updated
10/04/2023
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