Provider Demographics
NPI:1417952268
Name:DIALYSIS CLINIC INC
Entity Type:Organization
Organization Name:DIALYSIS CLINIC INC
Other - Org Name:DCI LAB NASHVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-327-3061
Mailing Address - Street 1:2917 FOSTER CREIGHTON DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3705
Mailing Address - Country:US
Mailing Address - Phone:615-255-5227
Mailing Address - Fax:615-259-9321
Practice Address - Street 1:2917 FOSTER CREIGHTON DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3705
Practice Address - Country:US
Practice Address - Phone:615-255-5227
Practice Address - Fax:615-259-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN 1953291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37901988Medicaid
CT003112836Medicaid
GA00380388AMedicaid
IA1970426Medicaid
NY4909-843025A3OtherNEW YORK LAB LICENSE
MODC 702702903Medicaid
PA021177OtherPA LAB LICENSE
PA1007529840006Medicaid
CACOS 800031OtherCA LAB LICENSE
CAXLAB00790Medicaid
TN44D0659053OtherCLIA
AL003400559Medicaid
FL800011550OtherFL LAB LICENSE
AZ052598Medicaid
IN100018440AMedicaid
CO20884257Medicaid
TN74472Medicaid
MA0805076Medicaid
TNTN 1953OtherSTATE LICENSE
TN44D0659053OtherCLIA