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
144 SCOTT STATION RD, JEFFERSON CITY, MO 65109-4974
(573) 893-5220
(573) 659-7516
Mailing address
144 SCOTT STATION RD, JEFFERSON CITY, MO 65109-4974
(573) 893-5220
(573) 659-7516
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501565121
—
MO
Enumeration date
07/08/2006
Last updated
10/04/2023
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