Organization
DIALYSIS CLINIC INC.
Active
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
6104 N MACK SMITH RD, EAST RIDGE, TN 37412-3960
(423) 894-8133
(423) 894-8337
Mailing address
6104 N MACK SMITH RD, EAST RIDGE, TN 37412-3960
(423) 894-8133
(426) 894-8337
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0000000050
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000551867B
—
GA
05
—
00551867A
—
GA
05
—
044-2514
—
TN
05
—
62085048-17
—
IL
Enumeration date
06/30/2006
Last updated
10/04/2023
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