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
645 BROADWAY, SOMERVILLE, MA 02145-2528
(617) 956-6389
(617) 616-3699
Mailing address
645 BROADWAY, SOMERVILLE, MA 02145-2528
(617) 616-3600
(617) 616-3699
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E90R
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1312286
—
MA
Enumeration date
07/08/2006
Last updated
10/05/2023
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