Organization
DIALYSIS CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONOVAN SCHULTZ (PRESIDENT)
(615) 327-3061
Entity
Organization
Contact information
Practice address
1207 17TH ST, PORTSMOUTH, OH 45662-3573
(740) 351-0596
(740) 351-0647
Mailing address
1207 17TH ST, PORTSMOUTH, OH 45662-3573
(740) 351-0596
(740) 351-0647
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0664DC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2310430
—
OH
05
—
39000351
—
KY
Enumeration date
07/08/2006
Last updated
10/04/2023
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