Organization
DIALYSIS CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONOVAN SCHULTZ (PRESIDENT)
(615) 327-3061
Entity
Organization
Contact information
Practice address
205 RIDGE RD, FAIRFIELD, ME 04937-3376
(207) 238-9321
(207) 238-9456
Mailing address
149 NORTH ST, MGMC - THAYER CAMPUS - DIALYSIS, WATERVILLE, ME 04901-4974
(207) 872-1291
(207) 872-1091
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
—
1902228513
—
ME
Enumeration date
01/16/2014
Last updated
10/05/2023
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