Organization
JEFFERSON CITY RENAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONOVAN SCHULTZ (PRESIDENT OF MEMBER)
(615) 327-3061
Entity
Organization
Contact information
Practice address
1241 W STADIUM BLVD # LL1, JEFFERSON CITY, MO 65109-6023
(573) 632-2633
(573) 632-4393
Mailing address
1633 CHURCH ST STE 500, NASHVILLE, TN 37203-2948
(615) 342-0552
(615) 341-9261
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
11/08/2017
Last updated
04/03/2024
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