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
1515 N HEARNE AVE, SHREVEPORT, LA 71107-7108
(318) 220-7012
(318) 220-7013
Mailing address
1515 N HEARNE AVE, 1515 NORTH HEARNE, SHREVEPORT, LA 71107-7108
(318) 220-7012
(318) 220-7013
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
140
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1627674
—
LA
05
—
HO4527918
—
TX
Enumeration date
07/19/2006
Last updated
10/05/2023
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