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
463 W 9TH ST, LIBBY, MT 59923
(406) 293-9913
(406) 293-9915
Mailing address
1633 CHURCH ST STE 500, NASHVILLE, TN 37203-2948
(615) 342-0498
(615) 963-9730
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
10429
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0730116
—
MT
05
—
8064011 00
—
ID
Enumeration date
07/08/2006
Last updated
10/04/2023
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